Individual
JASON LEE FAIRWEATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, SACIT, CSIT
Contact information
Practice address
553 BROADWAY, BERLIN, WI 54923-1323
(920) 204-6590
Mailing address
553 BROADWAY, BERLIN, WI 54923-1323
(920) 204-6590
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10532-125
WI
Other
Enumeration date
11/23/2020
Last updated
09/26/2023
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