Provider Demographics
NPI:1972510121
Name:CRUM, ROGER STEPHAN (LCPC)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:STEPHAN
Last Name:CRUM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 22ND ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1544
Mailing Address - Country:US
Mailing Address - Phone:630-571-1077
Mailing Address - Fax:
Practice Address - Street 1:210 W 22ND ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1544
Practice Address - Country:US
Practice Address - Phone:630-571-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL552101YA0400X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL552OtherADDICTIONS COUNSELOR