MEDICARE: MRS. ELIZABETH PAIGE RHYNE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.102104	IL
2	1041C0700X	Clinical Social Worker	149.020568	IL

General Provider Information

NPI Number	:	1255883617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH PAIGE RHYNE LCSW

Provider Business Mailing Address
First Line	:	3371 CARBINEER DR
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-9731
Country	:	US
Telephone Number	:	618-303-2666
Fax Number	:	779-666-8044

Provider Business Practice Location Address
First Line	:	1643 N ALPINE RD UNIT 104-108
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1462
Country	:	US
Telephone Number	:	618-303-2666
Fax Number	:	779-666-8044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	11/16/2021

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