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General NPI Number Information
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NPI Number | 1922326875
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Entity Type | Organization
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Legal Business Name | ROCK RIVER VALLEY MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 05/16/2010
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 631 WILLETT AVE
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City | DIXON
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State | IL
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Zip | 61021-2348
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Country | US
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Telephone | 815-284-6111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 564
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City | DIXON
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State | IL
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Zip | 61021-0564
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Country | US
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Telephone | 815-284-6111
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Fax | 815-284-6114
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CAROLYN SUE VAN DOREN
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Credential | PSY. D.
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Telephone | 815-284-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 071.007278
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 071.007278
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License Number State | IL
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