Provider Demographics
NPI:1992080451
Name:BROUWER, JASON JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:BROUWER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CHESTERFIELD LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4314
Mailing Address - Country:US
Mailing Address - Phone:419-578-7273
Mailing Address - Fax:
Practice Address - Street 1:135 CHESTERFIELD LN
Practice Address - Street 2:SUITE 200
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4314
Practice Address - Country:US
Practice Address - Phone:419-578-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical