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General NPI Number Information
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NPI Number | 1245385954
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Entity Type | Organization
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Legal Business Name | SWEDISHAMERICAN HOSPITAL
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1415 E STATE ST SUITE 900
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City | ROCKFORD
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State | IL
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Zip | 61104-2333
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Country | US
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Telephone | 815-489-4183
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1567
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City | ROCKFORD
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State | IL
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Zip | 61110-0067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | DON DANIELS
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Credential |
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Telephone | 815-966-2084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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