Provider Demographics
NPI:1205494408
Name:CHANCE, MEREDITH (LCSW)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:CHANCE
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 1:4119 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6154
Mailing Address - Country:US
Mailing Address - Phone:815-494-3692
Mailing Address - Fax:
Practice Address - Street 1:4320 SPRING CREEK RD
Practice Address - Street 2:STE 15
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1157
Practice Address - Country:US
Practice Address - Phone:815-494-3692
Practice Address - Fax:815-904-6419
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490212951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical