Healthcare Provider Details

I. General information

NPI: 1972133452
Provider Name (Legal Business Name): HANNAH M ROVEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH M JACOBS LCSW

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH ST
SPRINGFIELD IL
62702-5238
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-757-8161
Mailing address:
  • Phone: 217-545-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: