Provider Demographics
NPI:1538865563
Name:GLOVER-ROGERS, DONNA M (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:GLOVER-ROGERS
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 1:2049 N SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3823
Mailing Address - Country:US
Mailing Address - Phone:773-882-3625
Mailing Address - Fax:
Practice Address - Street 1:2049 N SAYRE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3823
Practice Address - Country:US
Practice Address - Phone:773-882-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NM417240103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool