Provider Demographics
NPI:1760849269
Name:RIEDELSPERGER, ELZONA FRANCIS (LCSW)
Entity Type:Individual
Prefix:
First Name:ELZONA
Middle Name:FRANCIS
Last Name:RIEDELSPERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-3448
Mailing Address - Country:US
Mailing Address - Phone:251-202-9449
Mailing Address - Fax:
Practice Address - Street 1:2332 10TH AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-3448
Practice Address - Country:US
Practice Address - Phone:251-202-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490182141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical