Basic Information
Provider Information
NPI: 1861479537
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BECHERER
FirstName: JANNA
MiddleName: K
NamePrefix: MRS.
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HOEKSTRA
OtherFirstName: JANNA
OtherMiddleName: K
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1601 PARKVIEW AVE
Address2: CREDENTIALING S200
City: ROCKFORD
State: IL
PostalCode: 611071822
CountryCode: US
TelephoneNumber: 8153955851
FaxNumber: 8153955644
Practice Location
Address1: 1601 PARKVIEW AVE
Address2: UNIVERSITY PSYCHIATRIC SERVICES
City: ROCKFORD
State: IL
PostalCode: 611071822
CountryCode: US
TelephoneNumber: 8153955874
FaxNumber: 8153955644
Other Information
ProviderEnumerationDate: 12/23/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X1800011925ILY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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