Provider Demographics
NPI:1851321525
Name:ROSKO, CHARLOTTE KELLY (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:KELLY
Last Name:ROSKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
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?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling