Provider Demographics
NPI:1922606235
Name:ROGERS, MATTHEW KENNETH (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KENNETH
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 S NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7266
Mailing Address - Country:US
Mailing Address - Phone:217-352-0200
Mailing Address - Fax:217-607-1139
Practice Address - Street 1:301 N NEIL ST STE 302
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3167
Practice Address - Country:US
Practice Address - Phone:217-352-0200
Practice Address - Fax:217-607-1139
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490225411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical