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General NPI Number Information
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NPI Number | 1457420358
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Entity Type | Organization
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Legal Business Name | LEANNE N RODGERS PSYD PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 600 DAVIS ST SUITE 3E
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City | EVANSTON
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State | IL
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Zip | 60201-4488
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Country | US
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Telephone | 773-294-6881
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Fax | 773-777-0667
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Provider Business Mailing Address
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Address Line | 600 DAVIS ST SUITE 3E
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City | EVANSTON
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State | IL
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Zip | 60201-4488
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Country | US
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Telephone | 773-294-6881
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Fax | 773-777-0667
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | LEANNE N RODGERS
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Credential | PSY.D.
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Telephone | 773-294-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.006113
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License Number State | IL
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