Gina Roak

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34007607A Issued in IN

Practice address

9495 Keilman St Ste 6
Saint John, IN 46373-9295

Phone

(219) 671-2128

NPI assigned

Feb 19, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1124443734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9495 KEILMAN ST STE 6",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739295",
            "telephone_number": "219-671-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9495 KEILMAN ST STE 6",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739295",
            "telephone_number": "219-671-2128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15494 98th Pl",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463117740",
            "country_code": "US",
            "telephone_number": "219-671-2128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "607 Lincolnway",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463835727",
            "country_code": "US",
            "telephone_number": "219-548-8727",
            "fax_number": "219-465-7211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROAK",
        "first_name": "GINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-19",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007607A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Saint John, IN
• Providers in Saint John, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.