Organization
CENTER FOR MARRIAGE AND FAMILY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN M SELANDER LCSW (CLINICAL DIRECTOR)
(815) 520-6972
Entity
Organization
Contact information
Practice address
4615 E STATE ST, SUITE 130, ROCKFORD, IL 61108-2100
(815) 391-3055
Mailing address
4615 E STATE ST, SUITE 130, ROCKFORD, IL 61108-2100
(815) 391-3055
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149017603
IL
Other
Enumeration date
01/23/2016
Last updated
01/23/2016
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