Healthcare Provider Details

I. General information

NPI: 1174074975
Provider Name (Legal Business Name): JAMES B GARRISON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 HONONEGAH RD UNIT 1
ROSCOE IL
61073-8682
US

IV. Provider business mailing address

1324 CAMP AVE
ROCKFORD IL
61103
US

V. Phone/Fax

Practice location:
  • Phone: 779-269-4011
  • Fax: 779-771-6343
Mailing address:
  • Phone: 815-222-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149024297
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: