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General NPI Number Information
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NPI Number | 1225643174
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Entity Type | Individual
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Provider Name | MR. JAY JACKSON SWANSON
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Gender | Male
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 6072 BRYNWOOD DR STE 205
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City | ROCKFORD
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State | IL
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Zip | 61114-5829
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Country | US
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Telephone | 815-846-0684
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Fax | 888-827-2114
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Provider Business Mailing Address
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Address Line | 4432 GLENMORE RD
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City | ROCKTON
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State | IL
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Zip | 61072-3234
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Country | US
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Telephone | 815-721-0189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180016565
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License Number State | IL
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