Provider Demographics
NPI:1417682253
Name:ROGERS, SAMUEL GEORGE (RBT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GEORGE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BIESTERFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3393
Mailing Address - Country:US
Mailing Address - Phone:630-999-8227
Mailing Address - Fax:
Practice Address - Street 1:901 BIESTERFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3393
Practice Address - Country:US
Practice Address - Phone:630-999-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician