Provider Demographics
NPI:1952731358
Name:ROSCKOWFF, LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
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 661
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-0661
Mailing Address - Country:US
Mailing Address - Phone:541-283-5929
Mailing Address - Fax:
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 560
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4791
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:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2691103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical