Healthcare Provider Details

I. General information

NPI: 1619549052
Provider Name (Legal Business Name): THRIVING SPARROW COUNSELING & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 STONEGATE RD
TROUT VALLEY IL
60013-2524
US

IV. Provider business mailing address

256 STONEGATE RD
TROUT VALLEY IL
60013-2524
US

V. Phone/Fax

Practice location:
  • Phone: 815-529-5933
  • Fax:
Mailing address:
  • Phone: 815-529-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ROCHON
Title or Position: OWNER
Credential: LCSW, RPT-S
Phone: 815-529-5933