Provider Demographics
NPI:1881823359
Name:ROCK, JENNY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:M
Last Name:ROCK
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 1:6014 WALNUT WAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-8243
Mailing Address - Country:US
Mailing Address - Phone:918-424-1786
Mailing Address - Fax:918-423-1204
Practice Address - Street 1:501 E DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5527
Practice Address - Country:US
Practice Address - Phone:918-424-1786
Practice Address - Fax:918-423-1204
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical