Provider Demographics
NPI:1013252733
Name:ROUILLARD, JESSICA ANN (IADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:ROUILLARD
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:SD
Mailing Address - Zip Code:57034-0343
Mailing Address - Country:US
Mailing Address - Phone:320-262-0433
Mailing Address - Fax:
Practice Address - Street 1:319 5TH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:SD
Practice Address - Zip Code:57034
Practice Address - Country:US
Practice Address - Phone:320-262-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11112101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)