Provider Demographics
NPI:1194998914
Name:RODGERS, LEANNE N (PSYD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:N
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DAVIS ST FL 3E
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4488
Mailing Address - Country:US
Mailing Address - Phone:773-294-6881
Mailing Address - Fax:773-777-0667
Practice Address - Street 1:600 DAVIS ST FL 3E
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4488
Practice Address - Country:US
Practice Address - Phone:773-294-6881
Practice Address - Fax:773-777-0667
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical