Provider Demographics
NPI:1184840647
Name:THOMSON, ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:THOMSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3751
Mailing Address - Country:US
Mailing Address - Phone:312-263-8034
Mailing Address - Fax:312-263-2289
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1008
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-263-8034
Practice Address - Fax:312-263-2289
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical