Healthcare Provider Details

I. General information

NPI: 1598270290
Provider Name (Legal Business Name): HANNAH ROGERS-O'BRIEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 OAK ST
NORTHFIELD IL
60093-3042
US

IV. Provider business mailing address

1850 OAK ST
NORTHFIELD IL
60093-3042
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax:
Mailing address:
  • Phone: 847-441-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.015035
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number20-239
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015035
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: