Healthcare Provider Details

I. General information

NPI: 1629044631
Provider Name (Legal Business Name): GREGORY M ROGERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W NORTHWEST HWY STE 103
MT PROSPECT IL
60056-2272
US

IV. Provider business mailing address

10 S DUNTON AVE APT 307
ARLINGTON HEIGHTS IL
60005-1485
US

V. Phone/Fax

Practice location:
  • Phone: 847-430-4324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.005989
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2520
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: