Provider Demographics
NPI:1861574550
Name:FITCH, JANE L (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:FITCH
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 1:905 E CLARK TRL
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4339
Mailing Address - Country:US
Mailing Address - Phone:618-925-3300
Mailing Address - Fax:
Practice Address - Street 1:387 E GROVE ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3728
Practice Address - Country:US
Practice Address - Phone:309-343-0311
Practice Address - Fax:309-343-0385
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical