Mari Evonne Kong, LCSW

NPI #1093044455 in Rockford, Illinois

Provider Information

NPI Number: 1093044455
Entity Type: Individual
Name: Mari Evonne Kong, LCSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LCSW
Enumeration Date: Dec 14, 2009
Last Updated: Dec 14, 2009

Practice Location

Address: 5301 E STATE ST STE 101
City: Rockford
State: Illinois
ZIP Code: 61108-2388
Phone: (815) 397-8500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary
Marriage & Family Therapist	106H00000X

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