Healthcare Provider Details

I. General information

NPI: 1831171529
Provider Name (Legal Business Name): LORI A ROKICKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 TRANSVERSE DR
TOLEDO OH
43614-8008
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-5695
  • Fax: 419-383-3031
Mailing address:
  • Phone: 419-383-5695
  • Fax: 419-383-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5966
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: