Provider Demographics
NPI:1952731358
Name:ROSCKOWFF, LEE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANN
Last Name:ROSCKOWFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LEEANN
Other - Middle Name:
Other - Last Name:ROSCKOWFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-0265
Mailing Address - Country:US
Mailing Address - Phone:541-283-5929
Mailing Address - Fax:
Practice Address - Street 1:7755 HWY 101 N
Practice Address - Street 2:STE SILETZ NORTH ONE
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388
Practice Address - Country:US
Practice Address - Phone:541-283-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4439103TC0700X
OR2691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical