Provider Demographics
NPI:1356726327
Name:ROSKO, JAN (LPC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:ROSKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 REGATTA LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9053
Mailing Address - Country:US
Mailing Address - Phone:319-899-4968
Mailing Address - Fax:
Practice Address - Street 1:7345 ADVENTURE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5000
Practice Address - Country:US
Practice Address - Phone:720-644-6730
Practice Address - Fax:719-960-2317
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013530101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor