Healthcare Provider Details

I. General information

NPI: 1154377414
Provider Name (Legal Business Name): RONDI J RORK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 DURAND AVE STE 450
RACINE WI
53406-5089
US

IV. Provider business mailing address

6015 DURAND AVE STE 450
RACINE WI
53406-5089
US

V. Phone/Fax

Practice location:
  • Phone: 262-884-4848
  • Fax: 262-886-6643
Mailing address:
  • Phone: 262-884-4848
  • Fax: 262-886-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1752
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: