Healthcare Provider Details

I. General information

NPI: 1023168515
Provider Name (Legal Business Name): JANE TAYLOR GREENFIELD D.MIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SPRING CREEK RD
ROCKFORD IL
61114-6315
US

IV. Provider business mailing address

1720 STRATFORD LN
ROCKFORD IL
61107-1366
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-6501
  • Fax: 815-397-6694
Mailing address:
  • Phone: 815-399-6501
  • Fax: 815-397-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: