Provider Demographics
NPI:1699947739
Name:ROGERS, REGINA SENESE
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:SENESE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:SENESE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75 EXECUTIVE DR STE 337
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8152
Mailing Address - Country:US
Mailing Address - Phone:331-444-2618
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR STE 337
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8152
Practice Address - Country:US
Practice Address - Phone:331-444-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty