Healthcare Provider Details

I. General information

NPI: 1164624706
Provider Name (Legal Business Name): ARICA JEAN ROCK M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

IV. Provider business mailing address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-8346
  • Fax: 309-662-0479
Mailing address:
  • Phone: 309-662-8346
  • Fax: 309-662-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147-001157
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001157
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: