Provider Demographics
NPI:1013204239
Name:ROCKMAN, RONALD WAYNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:ROCKMAN
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5068 TIMBER LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3975
Mailing Address - Country:US
Mailing Address - Phone:248-618-9049
Mailing Address - Fax:
Practice Address - Street 1:5068 TIMBER LAKE TRL
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3975
Practice Address - Country:US
Practice Address - Phone:248-618-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12002381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist