Provider Demographics
NPI:1790858389
Name:ROCKWELL, JANICE (MS,LIMHP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:MS,LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 APACHE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7500
Mailing Address - Country:US
Mailing Address - Phone:308-398-6050
Mailing Address - Fax:308-398-6051
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:360
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-398-6050
Practice Address - Fax:308-398-6051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE45101YA0400X
NE1121101YM0800X
NE465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025168300Medicaid
NE345584000OtherMAGELLEAN
NE84596OtherBLUE CROSS BLUE SHIELD