Healthcare Provider Details

I. General information

NPI: 1447164215
Provider Name (Legal Business Name): JAY SWANSON LCPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 GLENMORE RD
ROCKTON IL
61072-3234
US

IV. Provider business mailing address

4432 GLENMORE RD
ROCKTON IL
61072-3234
US

V. Phone/Fax

Practice location:
  • Phone: 815-393-9091
  • Fax: 815-594-5861
Mailing address:
  • Phone: 815-393-9091
  • Fax: 815-594-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAY SWANSON
Title or Position: MANAGER
Credential:
Phone: 815-393-9091