Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Glenn Sample, PSYD

Individual provider Professional Counselor · NPI 1881915270

Dr. Glenn Sample, PSYD is a Clinical Psychologist in Rockford, Illinois. Qualified in 2013, 13 years ago. Practices as a sole proprietor. Licensed in California and Illinois.

Years since qualifying
13
Licensed in
CA, IL
In the registry since
2010
Specialties on file
4
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

1643 N Alpine Rd Ste 104-609
Rockford, IL 61107-1462
Phone: (773) 245-3449
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 071009666 (IL)
Professional Counselor Taxonomy 101YP2500X · Licence 178010086 (IL)
Clinical Psychologist Taxonomy 103TC0700X · Licence 30340 (CA)
Professional Counselor Taxonomy 101YP2500X · Licence 180010078 (IL)

Record details

NPI number1881915270
Entity typeIndividual (Type 1)
GenderMale
Credentials PSYD
Sole proprietorYes
NPI enumeratedJune 20, 2010
Last updated in NPPESMarch 8, 2026
Certification dateMarch 8, 2026
Mailing address1643 N Alpine Rd Ste 104-609, Rockford, IL 61107-1462

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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