MEDICARE: DR. GLENN SAMPLE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178010086	IL
2	103TC0700X	Clinical Psychologist	30340	CA
3	101YP2500X	Professional Counselor	180010078	IL
4	103TC0700X	Clinical Psychologist	071009666	IL

General Provider Information

NPI Number	:	1881915270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN SAMPLE PSY.D.

Provider Business Mailing Address
First Line	:	1643 N ALPINE RD STE 104-609
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1462
Country	:	US
Telephone Number	:	773-245-3449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 N ALPINE RD STE 104-609
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1462
Country	:	US
Telephone Number	:	773-245-3449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2010
Last Update Date	:	03/08/2026

Similar Medicare Providers

1477923886 — EDGEBROOK PHYSICAL THERAPY, INC.
Practice Location Address:

1643 N ALPINE RD
ROCKFORD, IL
61107-1462

Practice Phone: 815-289-6942
Practice Fax: 815-547-1024

1447608492 — JESSICA STIER M.D.
Practice Location Address:

1643 N ALPINE RD STE 104-528
ROCKFORD, IL
61107-1462

Practice Phone: 815-324-0346
Practice Fax:

1255883617 — MRS. ELIZABETH PAIGE RHYNE LCSW
Practice Location Address:

1643 N ALPINE RD UNIT 104-108
ROCKFORD, IL
61107-1462

Practice Phone: 618-303-2666
Practice Fax: 779-666-8044

1336679653 — DR. CHELSEA JEAN FALCONER PT, DPT, ATC, CSCS
Practice Location Address:

1643 N ALPINE RD
ROCKFORD, IL
61107-1462

Practice Phone: 815-977-4095
Practice Fax:

1992650956 — MCO COUNSELING SERVICES LLC
Practice Location Address:

6735 VISTAGREEN WAY STE 200
ROCKFORD, IL
61107-5654

Practice Phone: 815-391-3055
Practice Fax:

1720934300 — LESLIE MARCUS LCSW
Practice Location Address:

1601 UNIVERSITY DR
ROCKFORD, IL
61107-5317

Practice Phone: 815-387-2521
Practice Fax:

Directions to “ DR. GLENN SAMPLE PSY.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.