Provider Demographics
NPI:1356850028
Name:O'ROURKE, JANICE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 LARKIN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119
Mailing Address - Country:US
Mailing Address - Phone:262-352-8488
Mailing Address - Fax:
Practice Address - Street 1:101 W BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4833
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:262-547-1608
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7015-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical