Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
Counseling & Consulting, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
920 W PRAIRIE DR, UNIT F, SYCAMORE, IL 60178-3123
(815) 889-0339
Mailing address
PO BOX 1567, ROCKFORD, IL 61110-0067
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010122910
BLUE CROSS
IL
Enumeration date
05/02/2008
Last updated
09/09/2011
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