Provider Demographics
NPI:1427017359
Name:GUNTHER, ROGER (LCSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:GUNTHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROCK HILL CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1241
Mailing Address - Country:US
Mailing Address - Phone:618-656-4847
Mailing Address - Fax:618-656-4847
Practice Address - Street 1:4 ROCK HILL CT
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1241
Practice Address - Country:US
Practice Address - Phone:618-656-4847
Practice Address - Fax:618-656-4847
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490040651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
772111OtherHEALTHLINK HMO & PPO
048669OtherVALUEOPTIONS
IL06032156OtherBCBS ILLINOIS
MO215100OtherBCBS OF MO - HMO
IL212113Medicare ID - Type UnspecifiedMEDICARE ILLINOIS