Healthcare Provider Details

I. General information

NPI: 1194067140
Provider Name (Legal Business Name): JILLIAN MCGUINNESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2013
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 19TH ST STE 102
ROCK ISLAND IL
61201-8022
US

IV. Provider business mailing address

209 N EUCLID AVE
PRINCETON IL
61356-1422
US

V. Phone/Fax

Practice location:
  • Phone: 94-077-8003
  • Fax:
Mailing address:
  • Phone: 815-200-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149024111
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.018135
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: