=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730598848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE EDGE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2014
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 PARK ST STE 190
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-4864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-444-2618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1717 PARK ST STE 190
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-4864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-444-2618
-----------------------------------------------------
Fax | 844-802-2872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | REGINA ROGERS
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 331-444-2618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180007828
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------