Provider Demographics
NPI:1750564571
Name:ROCKELMAN, MARILYNN A (MC)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:A
Last Name:ROCKELMAN
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 VINE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2164
Mailing Address - Country:US
Mailing Address - Phone:801-755-2013
Mailing Address - Fax:801-272-4644
Practice Address - Street 1:1881 VINE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2164
Practice Address - Country:US
Practice Address - Phone:801-755-2013
Practice Address - Fax:801-272-4644
Is Sole Proprietor?:No
Enumeration Date:2007-12-15
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5172598-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional