Healthcare Provider Details

I. General information

NPI: 1760615645
Provider Name (Legal Business Name): STEVEN E. ROTHKE, PH.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 COMMERCIAL AVE SUITE 1
NORTHBROOK IL
60062-1831
US

IV. Provider business mailing address

3710 COMMERCIAL AVE SUITE 1
NORTHBROOK IL
60062-1831
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-5744
  • Fax: 847-480-5755
Mailing address:
  • Phone: 847-480-5744
  • Fax: 847-480-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071-003201
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN E ROTHKE
Title or Position: CONSULTING PSYCHOLOGIST
Credential: PH.D.
Phone: 847-480-5744