Basic Information
| Provider Information | |||||||||
| NPI: | 1366924243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARROW | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 LEE ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600166574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774864140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12075 CORPORATE PKWY STE 110 | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530922664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668156592 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 1858833 | WI | N | 106S00000X | RBT-18-58833 | WI | N | 101YP2500X | 10023-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.