Provider Demographics
NPI:1053645176
Name:ROZESKE, JORDAN L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:ROZESKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:L
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 CHAPEL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6428
Mailing Address - Country:US
Mailing Address - Phone:608-512-6109
Mailing Address - Fax:608-807-5167
Practice Address - Street 1:2940 CHAPEL VALLEY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6428
Practice Address - Country:US
Practice Address - Phone:608-819-6390
Practice Address - Fax:608-807-5167
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8018-1231041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100029476Medicaid