Individual
BRUCE PERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1752 WINDSOR RD STE 203, LOVES PARK, IL 61111-4276
(815) 986-1113
(815) 986-1119
Mailing address
1210 E GATE PKWY, ROCKFORD, IL 61108-6137
(815) 986-1113
(815) 986-1119
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-007548
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149-007548
STATE OF ILLINOIS LICENSE
IL
Enumeration date
02/14/2012
Last updated
02/14/2012
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