MEDICARE: CHARLOTTE KELLY ROSKO PHD

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	103TC1900X	Counseling Psychologist	617	OK

General Provider Information

NPI Number	:	1851321525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE KELLY ROSKO PHD

Provider Business Mailing Address
First Line	:	1125 N PORTER AVE
Second Line	:	STE 303
City	:	NORMAN
State	:	OK
Zip	:	73071-6446
Country	:	US
Telephone Number	:	405-364-3804
Fax Number	:	405-292-3640

Provider Business Practice Location Address
First Line	:	1125 N PORTER AVE
Second Line	:	STE 303
City	:	NORMAN
State	:	OK
Zip	:	73071-6446
Country	:	US
Telephone Number	:	405-364-3804
Fax Number	:	405-292-3640

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/08/2008

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Directions to “ CHARLOTTE KELLY ROSKO PHD” Practice Location

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