Provider Demographics
NPI:1831129501
Name:CHARLOTTE KELLY ROSKO PHD INC
Entity Type:Organization
Organization Name:CHARLOTTE KELLY ROSKO PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ROSKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-364-3804
Mailing Address - Street 1:1125 N PORTER AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6446
Mailing Address - Country:US
Mailing Address - Phone:405-364-3804
Mailing Address - Fax:405-292-3640
Practice Address - Street 1:1125 N PORTER AVE
Practice Address - Street 2:STE 303
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6446
Practice Address - Country:US
Practice Address - Phone:405-364-3804
Practice Address - Fax:405-292-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK617103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty