Provider Demographics
NPI:1598929341
Name:ROCKWELL, JACQUELINE ANNE
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PERRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570
Mailing Address - Country:US
Mailing Address - Phone:951-436-5200
Mailing Address - Fax:
Practice Address - Street 1:555 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERIS
Practice Address - State:CA
Practice Address - Zip Code:92570
Practice Address - Country:US
Practice Address - Phone:951-436-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health