Provider Demographics
NPI:1154377414
Name:RORK, RONDI J (PHD)
Entity type:Individual
Prefix:DR
First Name:RONDI
Middle Name:J
Last Name:RORK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 DURAND AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5089
Mailing Address - Country:US
Mailing Address - Phone:262-884-4848
Mailing Address - Fax:262-886-6643
Practice Address - Street 1:6015 DURAND AVE
Practice Address - Street 2:STE 450
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5089
Practice Address - Country:US
Practice Address - Phone:262-884-4848
Practice Address - Fax:262-886-6643
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical