=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447164215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY SWANSON LCPC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4432 GLENMORE RD
-----------------------------------------------------
City | ROCKTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61072-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-393-9091
-----------------------------------------------------
Fax | 815-594-5861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4432 GLENMORE RD
-----------------------------------------------------
City | ROCKTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61072-3234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-393-9091
-----------------------------------------------------
Fax | 815-594-5861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JAY SWANSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-393-9091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------