MEDICARE: MRS. CECILY DEVON PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		IL

General Provider Information

NPI Number	:	1093677833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CECILY DEVON PERRY

Provider Business Mailing Address
First Line	:	1111 S ALPINE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-3940
Country	:	US
Telephone Number	:	331-701-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 S ALPINE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-3940
Country	:	US
Telephone Number	:	331-701-3520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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