Individual provider · Type 1 NPI
Ian Victor Provo
Clinical Social Worker · Rockford, IL
Practice location
1126 Post Dr
Rockford, IL 61108-4251
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Social Worker Primary | 1041C0700X | 149006049 (IL) |
Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…
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About NPI 1235614124
Ian Victor Provo's National Provider Identifier is 1235614124, issued on Sep 26, 2018. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Rockford, IL. The record was last updated on Sep 26, 2018.