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General NPI Number Information
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NPI Number | 1669715173
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Entity Type | Individual
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Provider Name | JESSICA MARIE NORMAN MS, LMFT, CADC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 3815 HARRISON AVE
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City | ROCKFORD
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State | IL
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Zip | 61108-7631
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Country | US
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Telephone | 815-387-2453
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Fax | 815-387-7997
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Provider Business Mailing Address
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Address Line | 3815 HARRISON AVE
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City | ROCKFORD
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State | IL
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Zip | 61108-7631
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Country | US
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Telephone | 815-387-2453
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Fax | 815-387-7997
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 321-228
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 16793-130
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001087
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License Number State | IL
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