Individual
JACQUELYN JOYCE ROGNSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
81 E GRAND AVE, FOX LAKE, IL 60020-1557
(224) 908-3005
(815) 814-8989
Mailing address
38675 N HILLTOP AVE, ANTIOCH, IL 60002-9630
(847) 395-4557
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.395865
IL
251S00000X
Community/Behavioral Health Agency
—
—
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770018780
—
IL
Enumeration date
04/27/2017
Last updated
11/29/2017
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