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IAN PROVO
Clinical Social Worker
NPI: 1235614124IndividualAccepts Medicare
Specialties, Licenses & Credentials
Clinical Social WorkerPrimary
Social Worker — Clinical
Code: 1041C0700X
149006049(IL)
CMS Specialties
PrimaryCLINICAL SOCIAL WORKER
Education
OTHER
Class of 1991
Contact & Hours
- Address
- 1126 POST DR
ROCKFORD, IL 61108 - Phone
- (815) 229-3738
Quick Facts
- NPI
- 1235614124
- Entity Type
- Individual
- Gender
- Male
- Medicare
- Accepted
- Specialties
- 1
- Locations
- 1
- Years in Practice
- 35
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