Healthcare Provider Details

I. General information

NPI: 1932859576
Provider Name (Legal Business Name): ROSALIND C. RODGERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 N LINCOLN AVE
CHICAGO IL
60657-1137
US

IV. Provider business mailing address

3523 N LINCOLN AVE
CHICAGO IL
60657-1137
US

V. Phone/Fax

Practice location:
  • Phone: 847-474-9963
  • Fax: 888-281-2948
Mailing address:
  • Phone: 847-474-9963
  • Fax: 847-281-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSALIND CHRISTINA RODGERS
Title or Position: THERAPIST
Credential: LCPC, BC-DMT
Phone: 847-474-9963