Provider Demographics
NPI:1144824574
Name:JASPER, JOHNNIE L
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:L
Last Name:JASPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRAL PUBLIC HEALTH CENTER (CPHC)
Mailing Address - Street 2:111 N. COUNTY FARM ROAD
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-627-1700
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL PUBLIC HEALTH CENTER (CPHC)
Practice Address - Street 2:111 N. COUNTY FARM ROAD
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-627-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)