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Individual

ROGER ALLEN SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMFT

Contact information

Practice address
1003 MARTIN LUTHER KING DR, BLOOMINGTON, IL 61701-1429
(309) 820-3500
Mailing address
12 RIGGS DR, LINCOLN, IL 62656-1014
(217) 735-2628

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IL

Other

Enumeration date
06/14/2007
Last updated
07/08/2007
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