Healthcare Provider Details

I. General information

NPI: 1538644711
Provider Name (Legal Business Name): YARITZA ROLON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YARITZA ROLON PSYD

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E BADGER DR
TOMAH WI
54660-5179
US

IV. Provider business mailing address

14398 GEMSTONE RD
SPARTA WI
54656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 608-313-7601
  • Fax:
Mailing address:
  • Phone: 608-473-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4114-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: