Provider Demographics
NPI:1780853010
Name:ROSHON, CHERI BETH (CMT)
Entity type:Individual
Prefix:MS
First Name:CHERI
Middle Name:BETH
Last Name:ROSHON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:CHERI
Other - Middle Name:BETH
Other - Last Name:OELKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:13035 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:MAZEPPA
Mailing Address - State:MN
Mailing Address - Zip Code:55956-4214
Mailing Address - Country:US
Mailing Address - Phone:507-356-8309
Mailing Address - Fax:
Practice Address - Street 1:322 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-8605
Practice Address - Country:US
Practice Address - Phone:507-356-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0020171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor