MEDICARE: SHALEESE ROCKETT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2024010830	MO

General Provider Information

NPI Number	:	1306444781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALEESE ROCKETT LCSW

Provider Business Mailing Address
First Line	:	1133 W MAIN ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3694
Country	:	US
Telephone Number	:	816-200-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 W MAIN ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3694
Country	:	US
Telephone Number	:	816-200-2753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/10/2024

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Directions to “ SHALEESE ROCKETT LCSW” Practice Location

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