Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ian Victor Provo

Individual provider Clinical Social Worker · NPI 1235614124

Ian Victor Provo is a Clinical Social Worker in Rockford, Illinois. Qualified in 1991, 35 years ago. Practices with Mccd Psychiatry Services PLLC, a 206-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
35
Licensed in
IL
In the registry since
2018
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Practice location Address checks out

1126 Post Dr
Rockford, IL 61108-4251
Phone: (815) 229-3738
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149006049 (IL)

Record details

NPI number1235614124
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 26, 2018
Last updated in NPPESSeptember 26, 2018
Mailing address1126 Post Dr, Rockford, IL 61108-4251

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1991 (35 years in practice)
Group practice McCd Psychiatry Services Pllc — 206 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Rockford