Provider Demographics
NPI:1518486463
Name:MANZANO, ROCHELLE (MS MFT)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:MANZANO
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S 8TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4468
Mailing Address - Country:US
Mailing Address - Phone:920-323-7431
Mailing Address - Fax:
Practice Address - Street 1:615 S 8TH ST STE 220
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4468
Practice Address - Country:US
Practice Address - Phone:920-323-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI583-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist