MEDICARE: MRS. CHERYL SUE SWENNY LCPC

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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1578679874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL SUE SWENNY LCPC

Provider Business Mailing Address
First Line	:	PO BOX 18
Second Line	:	201 SOUTH WALNUT
City	:	ROCHESTER
State	:	IL
Zip	:	62563
Country	:	US
Telephone Number	:	217-498-7600
Fax Number	:	217-498-8093

Provider Business Practice Location Address
First Line	:	201 SOUTH WALNUT
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563
Country	:	US
Telephone Number	:	217-498-7600
Fax Number	:	217-498-8093

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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