MEDICARE: LISA ROOKER CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA-060255	OH
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710593736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ROOKER CDCA

Provider Business Mailing Address
First Line	:	5439 BURKHARDT RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-2111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31500 CHIEFTAIN DR
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-8421
Country	:	US
Telephone Number	:	740-270-3286
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	04/19/2023

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