Provider Demographics
NPI:1962162032
Name:WROCKLAGE, GENNY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:GENNY
Middle Name:LYNN
Last Name:WROCKLAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W GRAND AVE UNIT 3402
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2582
Mailing Address - Country:US
Mailing Address - Phone:619-325-9109
Mailing Address - Fax:
Practice Address - Street 1:730 W GRAND AVE UNIT 3402
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2582
Practice Address - Country:US
Practice Address - Phone:619-325-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical