Healthcare Provider Details

I. General information

NPI: 1659306876
Provider Name (Legal Business Name): MICHELLE R ROOKER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE R BROOKS L.C.S.W

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 BRIARWOOD
JACKSON MO
63755-1053
US

IV. Provider business mailing address

1512 BRIARWOOD
JACKSON MO
63755-1053
US

V. Phone/Fax

Practice location:
  • Phone: 540-845-0763
  • Fax: 866-455-5064
Mailing address:
  • Phone: 540-845-0763
  • Fax: 866-455-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006644
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024031448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: