Provider Demographics
NPI:1447679006
Name:ROOKS, ICY
Entity type:Individual
Prefix:
First Name:ICY
Middle Name:
Last Name:ROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 ROYALMILE WAY
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9001
Mailing Address - Country:US
Mailing Address - Phone:702-945-5208
Mailing Address - Fax:702-586-6645
Practice Address - Street 1:915 ROYALMILE WAY
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9001
Practice Address - Country:US
Practice Address - Phone:702-945-5208
Practice Address - Fax:702-586-6645
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst