Healthcare Provider Details

I. General information

NPI: 1912374091
Provider Name (Legal Business Name): JEAN F. ROCK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 12/10/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W MONROE ST STE 1100
CHICAGO IL
60606-5170
US

IV. Provider business mailing address

230 W MONROE ST STE 1100
CHICAGO IL
60606-5170
US

V. Phone/Fax

Practice location:
  • Phone: 855-275-5237
  • Fax:
Mailing address:
  • Phone: 855-275-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180013564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: