Individual
COLLENE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.P.C.
Contact information
Practice address
7210 E STATE ST, ROCKFORD, IL 61108-2622
(815) 839-2064
(815) 839-2114
Mailing address
7210 E STATE ST, ROCKFORD, IL 61108-2622
(815) 839-2064
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180-008117
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21350
NATIONAL BOARD CERTIFIACTION
—
Enumeration date
02/09/2012
Last updated
10/12/2021
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