Provider Demographics
NPI:1033240486
Name:ROLLEN, MISTY RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:RENEE
Last Name:ROLLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0964
Mailing Address - Country:US
Mailing Address - Phone:765-674-9070
Mailing Address - Fax:
Practice Address - Street 1:4011 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4904
Practice Address - Country:US
Practice Address - Phone:765-674-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor