Provider Demographics
NPI:1023168515
Name:TAYLOR GREENFIELD, JANE (DMIN LCPC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:TAYLOR GREENFIELD
Suffix:
Gender:F
Credentials:DMIN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 STRATFORD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1366
Mailing Address - Country:US
Mailing Address - Phone:815-399-6501
Mailing Address - Fax:815-397-6694
Practice Address - Street 1:4500 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6315
Practice Address - Country:US
Practice Address - Phone:815-399-6501
Practice Address - Fax:815-397-6694
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132119OtherBLUECROSS BLUESHIELD