Roark, Jenny

Roark, Jenny is an individual health care provider with primary practice located at Rr 1 Box 277 , Lawrenceville IL 62439-9784. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Roark, Jenny can be contacted via phone (618) 943-3754.

Contact Information

Primary practice address
Rr 1 Box 277 Lawrenceville IL 62439-9784
Phone: (618) 943-3754
Fax: (618) 943-3657
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1932484771
LBN Legal business name Roark, Jenny
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2011
Last updated Oct 12th, 2011 - about 13 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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Identifiers

StateTypeNumberIssuer
All States NPI 1932484771 NPPES
Illinois MEDICAID 376006178008

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