Provider Demographics
NPI:1386177491
Name:UNRUH, JASON JAMES (BS, CSAC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:UNRUH
Suffix:
Gender:M
Credentials:BS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 W FERNWOOD CIR
Mailing Address - Street 2:APT.1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3953
Mailing Address - Country:US
Mailing Address - Phone:414-698-6024
Mailing Address - Fax:
Practice Address - Street 1:2319 W. CAPTIAL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1919
Practice Address - Country:US
Practice Address - Phone:414-442-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16153-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)