Healthcare Provider Details

I. General information

NPI: 1699947739
Provider Name (Legal Business Name): MRS. REGINA SENESE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA SENESE YOUNG

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EXECUTIVE DR STE 337
AURORA IL
60504-8152
US

IV. Provider business mailing address

75 EXECUTIVE DR STE 337
AURORA IL
60504-8152
US

V. Phone/Fax

Practice location:
  • Phone: 331-444-2618
  • Fax:
Mailing address:
  • Phone: 331-444-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101YP2500X
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: