| Citied | |
|
5301 E State St Ste 309a Rockford IL 61108-2399 | |
| (608) 713-3454 | |
| Not Available |
| Full Name | Citied |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5301 E State St Ste 309a, Rockford, Illinois |
| Authorized Official Name and Position | Ashton Rae Lockhart (SOLE PROPRIETOR) |
| Authorized Official Contact | 6087133454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Citied 1907 Jonathan Ave Rockford IL 61103-2908 Ph: (815) 621-3853 | Citied 5301 E State St Ste 309a Rockford IL 61108-2399 Ph: (608) 713-3454 |
| NPI Number | 1881372308 |
|---|---|
| Provider Enumeration Date | 07/05/2023 |
| Last Update Date | 10/19/2023 |
| Certification Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881372308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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