Provider Demographics
NPI:1912793258
Name:KEIST, JASON A (MSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:KEIST
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7008
Mailing Address - Country:US
Mailing Address - Phone:217-766-0555
Mailing Address - Fax:
Practice Address - Street 1:1701 S PROSPECT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7054
Practice Address - Country:US
Practice Address - Phone:217-840-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty