Provider Demographics
NPI:1013198415
Name:ROSKE, CASSIDY MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:MICHELLE
Last Name:ROSKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:MICHELLE
Other - Last Name:ZAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:409 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4520
Mailing Address - Country:US
Mailing Address - Phone:208-234-2646
Mailing Address - Fax:208-232-0035
Practice Address - Street 1:409 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4520
Practice Address - Country:US
Practice Address - Phone:208-234-2646
Practice Address - Fax:208-232-0035
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional