Provider Demographics
NPI:1932443009
Name:ROYSE ROSKOWSKI, JANE (PHD, LP, LPC)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:ROYSE ROSKOWSKI
Suffix:
Gender:F
Credentials:PHD, LP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HYLAND GREENS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3934
Mailing Address - Country:US
Mailing Address - Phone:952-993-2400
Mailing Address - Fax:952-993-2522
Practice Address - Street 1:13100 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1810
Practice Address - Country:US
Practice Address - Phone:952-206-2040
Practice Address - Fax:952-206-2041
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACADC 4441101YA0400X
PRPC000514101YP2500X
NC4279103TC0700X
MNLP5637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional