Provider Demographics
NPI:1346324936
Name:EDLEMAN, WILLIAM C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:EDLEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6085 STRATHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6635
Mailing Address - Country:US
Mailing Address - Phone:815-227-1522
Mailing Address - Fax:815-227-1542
Practice Address - Street 1:6085 STRATHMOOR DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6635
Practice Address - Country:US
Practice Address - Phone:815-227-1522
Practice Address - Fax:815-227-1542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL932840Medicare ID - Type Unspecified