Provider Demographics
NPI:1902864309
Name:ROURKE, COLLEEN PATRICIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:ROURKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:PATRICIA
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1852 N 69TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2316
Mailing Address - Country:US
Mailing Address - Phone:414-453-0303
Mailing Address - Fax:
Practice Address - Street 1:12970 W BLUEMOUND RD
Practice Address - Street 2:SUITE 308
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-780-1020
Practice Address - Fax:262-780-1022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional