MEDICARE: DAPHNE PERKINS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1497296057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE PERKINS

Provider Business Mailing Address
First Line	:	1711 28TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-3728
Country	:	US
Telephone Number	:	309-373-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 28TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-3728
Country	:	US
Telephone Number	:	309-373-5503
Fax Number	:

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

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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