Individual
MR. JERALD RAY NORQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.C.
Contact information
Practice address
5702 ELAINE DR, ROCKFORD, IL 61108-2458
(815) 229-7102
Mailing address
905 SAINT ANDREWS WAY, ROCKFORD, IL 61107-3847
(815) 398-3476
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.004957
IL
Other
Enumeration date
06/26/2008
Last updated
06/26/2008
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