Provider Demographics
NPI:1669655064
Name:ROECKEMAN, STEPHEN JOHN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:ROECKEMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4309
Mailing Address - Country:US
Mailing Address - Phone:217-898-6773
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4579
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program