Provider Demographics
NPI:1386037778
Name:ROSKUSZKA, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:ROSKUSZKA
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 1:26W340 THORNGATE LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2375
Mailing Address - Country:US
Mailing Address - Phone:630-408-8853
Mailing Address - Fax:
Practice Address - Street 1:141 E 12TH ST
Practice Address - Street 2:DEVOS FIELDHOUSE
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3607
Practice Address - Country:US
Practice Address - Phone:616-395-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program