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: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 PARK ST STE 190
NAPERVILLE IL
60563-6713
US

IV. Provider business mailing address

1717 PARK ST STE 190
NAPERVILLE IL
60563-6713
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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number180007828
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: