Individual
MRS. HEATHER JOY ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY D, LP
Contact information
Practice address
624 13TH ST S, VIRGINIA, MN 55792-3149
(218) 749-2881
(218) 749-3806
Mailing address
PO BOX 1188, VIRGINIA, MN 55792-1188
(218) 749-2881
(218) 749-3806
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5089
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/10/2006
Last updated
12/08/2014
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