Provider Demographics
NPI:1124590906
Name:JERDING, AIMEE MICHELLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:MICHELLE
Last Name:JERDING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 FEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6300
Mailing Address - Country:US
Mailing Address - Phone:815-387-5309
Mailing Address - Fax:
Practice Address - Street 1:816 FEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6300
Practice Address - Country:US
Practice Address - Phone:815-387-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker