Provider Demographics
NPI:1659354330
Name:FISCHER-CASEY, JACALYN DALE (LCPC)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:DALE
Last Name:FISCHER-CASEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 N LONGWOOD ST
Mailing Address - Street 2:STE 203
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4266
Mailing Address - Country:US
Mailing Address - Phone:815-962-6100
Mailing Address - Fax:815-962-6107
Practice Address - Street 1:631 N LONGWOOD ST
Practice Address - Street 2:STE 203
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4266
Practice Address - Country:US
Practice Address - Phone:815-962-6100
Practice Address - Fax:815-962-6107
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3810101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional