Healthcare Provider Details

I. General information

NPI: 1255294930
Provider Name (Legal Business Name): JACEY VAN ROEKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 6TH AVE E
OSKALOOSA IA
52577-3805
US

IV. Provider business mailing address

409 6TH AVE E
OSKALOOSA IA
52577-3805
US

V. Phone/Fax

Practice location:
  • Phone: 641-295-5229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131314
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: