Provider Demographics
NPI:1245027861
Name:ROGERS, JANAE NEYCOLE (MED)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:NEYCOLE
Last Name:ROGERS
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 WASHINGTON AVE # M3
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1448
Mailing Address - Country:US
Mailing Address - Phone:708-664-7252
Mailing Address - Fax:708-664-7252
Practice Address - Street 1:12231 WASHINGTON AVE # M3
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1448
Practice Address - Country:US
Practice Address - Phone:708-664-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist