Provider Demographics
NPI:1568735934
Name:ROSKAM, DOROTHY ELAINE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ELAINE
Last Name:ROSKAM
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1883
Mailing Address - Country:US
Mailing Address - Phone:712-722-4244
Mailing Address - Fax:712-722-2425
Practice Address - Street 1:45 2ND ST NE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1883
Practice Address - Country:US
Practice Address - Phone:712-722-4244
Practice Address - Fax:712-722-2425
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00823237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist