Provider Demographics
NPI:1033858535
Name:ROGGE, PAIGE DANIELLE (LSW)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:DANIELLE
Last Name:ROGGE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 US HWY 136
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:IL
Mailing Address - Zip Code:61865
Mailing Address - Country:US
Mailing Address - Phone:217-649-0492
Mailing Address - Fax:
Practice Address - Street 1:7757 US HWY 136
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865
Practice Address - Country:US
Practice Address - Phone:217-649-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501067751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
150106775OtherNATIONAL ASSOCIATION OF SOCIAL WORKERS