MEDICARE: JACQUELINE F GIFFORD

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
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1912849829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE F GIFFORD

Provider Business Mailing Address
First Line	:	4833 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-520-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4833 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-520-2303
Fax Number	:	866-516-7056

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ JACQUELINE F GIFFORD ” Practice Location

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