Healthcare Provider Details

I. General information

NPI: 1053665281
Provider Name (Legal Business Name): JENNIFER L. ROCKETT, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 BROADMOOR DR BUILDING DII SUITE 111
BRYAN TX
77802-2847
US

IV. Provider business mailing address

PO BOX 9276
COLLEGE STATION TX
77842-9276
US

V. Phone/Fax

Practice location:
  • Phone: 979-450-5320
  • Fax: 979-713-1245
Mailing address:
  • Phone: 979-450-5320
  • Fax: 979-713-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36024
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number36024
License Number StateTX

VIII. Authorized Official

Name: DR. JENNIFER LYNN ROCKETT
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 979-450-5320