MEDICARE: DR. RITA V ROGAN PH.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	103TC0700X	Clinical Psychologist	071.003645	IL
2	103TC0700X	Clinical Psychologist	6301005825	MI
3	103TF0000X	Family Psychologist	071.003645	IL
4	103TF0000X	Family Psychologist	6301005825	MI
5	103TH0004X	Health Psychologist	071.003645	IL
6	103TH0004X	Health Psychologist	6301005825	MI
7	103TP2701X	Group Psychotherapy Psychologist	071.003645	IL
8	103TP2701X	Group Psychotherapy Psychologist	6301005825	MI

General Provider Information

NPI Number	:	1942322938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA V ROGAN PH.D

Provider Business Mailing Address
First Line	:	600 S DEARBORN ST
Second Line	:	1709
City	:	CHICAGO
State	:	IL
Zip	:	60605-1821
Country	:	US
Telephone Number	:	708-383-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S DEARBORN ST
Second Line	:	1709
City	:	CHICAGO
State	:	IL
Zip	:	60605-1821
Country	:	US
Telephone Number	:	708-383-8686
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/23/2015

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