MEDICARE: DR. YARITZA ROLON PSYD

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	103TC1900X	Counseling Psychologist	4114-57	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4529608576604	OTHER	WI	DRIVERS

General Provider Information

NPI Number	:	1538644711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YARITZA ROLON PSYD

Provider Business Mailing Address
First Line	:	14398 GEMSTONE RD
Second Line	:
City	:	SPARTA
State	:	WI
Zip	:	54656-5332
Country	:	US
Telephone Number	:	608-473-4401
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E BADGER DR
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-5179
Country	:	US
Telephone Number	:	608-313-7601
Fax Number	:

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

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	01/05/2026

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