=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497550610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES ROGALSKY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 NORTHGATE INDUSTRIAL DR
-----------------------------------------------------
City | GRANITE CITY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62040-6805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-403-0835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5517 LA MOTTE LN
-----------------------------------------------------
City | GODFREY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62035-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-670-0474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------