Provider Demographics
NPI:1083771901
Name:FLESCH, JEANNE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:FLESCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 S MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3011
Mailing Address - Country:US
Mailing Address - Phone:815-397-4540
Mailing Address - Fax:815-398-4896
Practice Address - Street 1:415 S MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3011
Practice Address - Country:US
Practice Address - Phone:815-397-4540
Practice Address - Fax:815-398-4896
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490014091041C0700X
WI37071231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6232001Medicare PIN
IL990500Medicare ID - Type Unspecified