Provider Demographics
NPI:1326310459
Name:RONDI J RORK PHD LLC
Entity Type:Organization
Organization Name:RONDI J RORK PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:RORK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-884-4848
Mailing Address - Street 1:6015 DURAND AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5089
Mailing Address - Country:US
Mailing Address - Phone:262-884-4848
Mailing Address - Fax:
Practice Address - Street 1:6015 DURAND AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5089
Practice Address - Country:US
Practice Address - Phone:262-884-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1752-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty