MEDICARE: MIKAYLA ROSKENS PLMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	14602	NE

General Provider Information

NPI Number	:	1043046667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA ROSKENS PLMHP

Provider Business Mailing Address
First Line	:	1800 W PASEWALK AVE STE A
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-5657
Country	:	US
Telephone Number	:	402-500-6870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 W PASEWALK AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-5656
Country	:	US
Telephone Number	:	402-500-6870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	08/29/2025

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