Provider Demographics
NPI:1245506369
Name:ROGERS, TANYA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
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 1:15714 MARSHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4216
Mailing Address - Country:US
Mailing Address - Phone:708-651-1987
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?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490113461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical