Provider Demographics
NPI:1841279460
Name:PASKY, ROBERT III (MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PASKY
Suffix:III
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1912
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61110-0412
Mailing Address - Country:US
Mailing Address - Phone:815-229-1824
Mailing Address - Fax:815-229-8524
Practice Address - Street 1:129 S PHELPS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2453
Practice Address - Country:US
Practice Address - Phone:815-229-1824
Practice Address - Fax:815-229-8524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health