Provider Demographics
NPI:1891096954
Name:ROCKEY, AMANDA B (LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:ROCKEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:B
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:920 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1067
Mailing Address - Country:US
Mailing Address - Phone:815-844-6109
Mailing Address - Fax:815-844-3561
Practice Address - Street 1:920 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1067
Practice Address - Country:US
Practice Address - Phone:815-844-6109
Practice Address - Fax:815-844-3561
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional