| Rockford Anxiety And Phobic Clinic | |
|
429 Phelps Ave Building 7 Suite 11 Rockford IL 61108-2493 | |
| (815) 762-0903 | |
| (779) 500-0687 |
| Full Name | Rockford Anxiety And Phobic Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 429 Phelps Ave, Rockford, Illinois |
| Authorized Official Name and Position | Charles Doy Dudley (OWNER) |
| Authorized Official Contact | 8157620903 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockford Anxiety And Phobic Clinic 429 Phelps Ave Building 7 Suite 11 Rockford IL 61108-2493 Ph: (815) 762-0903 | Rockford Anxiety And Phobic Clinic 429 Phelps Ave Building 7 Suite 11 Rockford IL 61108-2493 Ph: (815) 762-0903 |
| NPI Number | 1598162554 |
|---|---|
| Provider Enumeration Date | 11/19/2014 |
| Last Update Date | 11/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598162554 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180000119 (Illinois) | Primary |
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