Individual
MR. JASON OWEN GREENLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, MHP
Contact information
Practice address
70 E WASHINGTON ST, CHAMPAIGN, IL 61820-3652
(217) 398-7785
(217) 398-7787
Mailing address
1510 W WHITE ST, CHAMPAIGN, IL 61821-3114
(217) 355-7622
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/04/2007
Last updated
08/21/2024
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