Provider Demographics
NPI:1437499621
Name:ROGERS, EMMA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:JEAN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 E 154TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3327
Mailing Address - Country:US
Mailing Address - Phone:708-339-0040
Mailing Address - Fax:708-339-0290
Practice Address - Street 1:174 E 154TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3327
Practice Address - Country:US
Practice Address - Phone:708-339-0040
Practice Address - Fax:708-339-0290
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490005371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical