Provider Demographics
NPI:1609469691
Name:ROSKA, STACEY MARIE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:ROSKA
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 1:2641 W ECHO DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4486
Mailing Address - Country:US
Mailing Address - Phone:208-818-8090
Mailing Address - Fax:
Practice Address - Street 1:2641 W ECHO DR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4486
Practice Address - Country:US
Practice Address - Phone:208-818-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty