Individual
DR. JEREMY B ROARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2650 SHUMAC LN SE, ADA, MI 49301-9355
(805) 570-7688
Mailing address
2650 SHUMAC LN SE, ADA, MI 49301-9355
(805) 570-7688
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 24012
CA
Other
Enumeration date
02/16/2011
Last updated
02/01/2024
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