Glenn Sample, Psy.D., PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GLENN SAMPLE, PSY.D., PLLC

Practice address

7210 E State St Ste 102
Rockford, IL 61108-2636

Phone

(773) 245-3449

NPI assigned

Oct 19, 2026

Last updated

Oct 19, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Sample, PSY.D.NPI 1881915270

Title

Clinical Psychologist

Phone

(773) 245-3449

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn Sample, PSY.D.

  • Clinical Psychologist
  • Rockford, IL
  • NPI 1881915270
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1792368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792368000000",
    "number": "1962308718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1643 N ALPINE RD # 104-609",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071462",
            "telephone_number": "773-245-3449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7210 E STATE ST STE 102",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082636",
            "telephone_number": "773-245-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN SAMPLE, PSY.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-19",
        "last_updated": "2026-10-19",
        "certification_date": "2026-10-18",
        "status": "A",
        "authorized_official_last_name": "SAMPLE",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-245-3449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.