Provider Demographics
NPI:1659587889
Name:BONGIORNO, MARGARET ROHDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ROHDE
Last Name:BONGIORNO
Suffix:
Gender:F
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:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-0453
Mailing Address - Country:US
Mailing Address - Phone:630-744-3450
Mailing Address - Fax:630-871-3784
Practice Address - Street 1:417 W ROOSEVELT RD
Practice Address - Street 2:SUITE 10A
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2320
Practice Address - Country:US
Practice Address - Phone:630-744-3450
Practice Address - Fax:630-871-3784
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-2801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL967620Medicare ID - Type Unspecified