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General NPI Number Information
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NPI Number | 1801970652
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Entity Type | Individual
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Provider Name | PATRICIA G ROURKE PHD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 2092 S CUSTER RD
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City | MONROE
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State | MI
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Zip | 48161-1831
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Country | US
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Telephone | 734-242-8711
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Fax | 734-242-3955
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Provider Business Mailing Address
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Address Line | 7550 LUCERNE DR SUITE 405
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130-6588
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Country | US
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Telephone | 440-234-8833
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Fax | 440-234-3313
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301006139
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License Number State | MI
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