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General NPI Number Information
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NPI Number | 1568562569
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Entity Type | Individual
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Provider Name | MISS JUANITA KATHLEEN ROGERS
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 820 S. DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-569-7208
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Fax |
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Provider Business Mailing Address
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Address Line | 9514 S. WENTWORTH AVE.
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City | CHICAGO
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State | IL
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Zip | 60628
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Country | US
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Telephone | 773-785-7712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14005659
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License Number State | IL
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