Individual
MRS. COLLEEN KATY ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP, MPA
Contact information
Practice address
640 E 152ND ST, PHOENIX, IL 60426-2454
(708) 271-3384
Mailing address
640 E 152ND ST, PHOENIX, IL 60426-2454
(708) 271-3384
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331622717001
—
IL
Enumeration date
08/03/2019
Last updated
08/03/2019
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