Provider Demographics
NPI:1518682624
Name:ROSKAM, SHELLEY LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:ROSKAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 CODY DR UNIT 8102
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2498
Mailing Address - Country:US
Mailing Address - Phone:563-343-2352
Mailing Address - Fax:
Practice Address - Street 1:275 NE VENTURE DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9655
Practice Address - Country:US
Practice Address - Phone:515-727-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN293981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical