Sample, Glenn

Sample, Glenn is an sole proprietor health care provider with primary practice located at 1643 N Alpine Rd Ste 104-609 , Rockford IL 61107-1462. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Sample, Glenn can be contacted via phone (773) 245-3449.

Contact Information

Primary practice address
1643 N Alpine Rd Ste 104-609 Rockford IL 61107-1462
Phone: (773) 245-3449
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 178010086 Illinois
Behavioral Health & Social Service Providers / Professional 101YP2500X 180010078 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 30340 California
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071009666 Illinois

Profile Details

NPI number 1881915270
LBN Legal business name Sample, Glenn
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 20th, 2010
Last updated Aug 4th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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