Provider Demographics
NPI:1548875628
Name:JANICE S BENEDICT PLLC
Entity type:Organization
Organization Name:JANICE S BENEDICT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:STRAND
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-399-8040
Mailing Address - Street 1:3710 CORBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3548
Mailing Address - Country:US
Mailing Address - Phone:815-399-8040
Mailing Address - Fax:815-395-0671
Practice Address - Street 1:6975 REDANSA DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1201
Practice Address - Country:US
Practice Address - Phone:815-398-7000
Practice Address - Fax:815-395-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health