Individual
MR. JERROLD BERNARD ROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSSW, LCSW
Contact information
Practice address
6270 N PORT WASHINGTON RD, SUITE 201, GLENDALE, WI 53217-4311
(414) 962-2284
Mailing address
5671 N MILWAUKEE RIVER PKWY, GLENDALE, WI 53209-4564
(414) 228-9282
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4219-123
WI
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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