Provider Demographics
NPI:1164907796
Name:ROSKOTT, SANDRA (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:ROSKOTT
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:MS
Other - First Name:SHAW
Other - Middle Name:
Other - Last Name:ROSKOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:685 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2117
Mailing Address - Country:US
Mailing Address - Phone:662-626-3303
Mailing Address - Fax:
Practice Address - Street 1:685 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2117
Practice Address - Country:US
Practice Address - Phone:662-626-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL73671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical