Dr Glenn Sample, PSYD is a
Psychologist - Clinical based in Rockford, Illinois. Dr Glenn Sample is licensed to practice in Illinois (license number 071009666) and his current practice location is
1643 N Alpine Rd Ste 104-609, Rockford, Illinois. He can be reached at his office (for appointments etc.) via phone at
(773) 245-3449.
NPI number for Dr Glenn Sample is 1881915270 and his current mailing address is 1643 N Alpine Rd Ste 104-609, Rockford, Illinois. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1881915270.
Healthcare Provider's Profile
| Full Name | Dr Glenn Sample |
|---|
| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 1643 N Alpine Rd Ste 104-609, Rockford, Illinois |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1881915270
- Provider Enumeration Date: 06/20/2010
- Last Update Date: 08/04/2021
Medical Identifiers
Medical identifiers for Dr Glenn Sample such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1881915270 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YP2500X | Counselor - Professional | 178010086 (Illinois) | Secondary |
| 101YP2500X | Counselor - Professional | 180010078 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 30340 (California) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071009666 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Glenn Sample is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Glenn Sample, PSYD
1643 N Alpine Rd Ste 104-609,
Rockford, IL 61107-1462
Ph: (773) 245-3449 | Dr Glenn Sample, PSYD
1643 N Alpine Rd Ste 104-609,
Rockford, IL 61107-1462
Ph: (773) 245-3449 |
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