Provider Demographics
NPI:1144352626
Name:ROSZKOWSKI, JOSEPH MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ROSZKOWSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28W671 GARYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1564
Mailing Address - Country:US
Mailing Address - Phone:630-293-9860
Mailing Address - Fax:630-293-9861
Practice Address - Street 1:28W671 GARYS MILL RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1564
Practice Address - Country:US
Practice Address - Phone:630-293-9860
Practice Address - Fax:630-293-9861
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208302046OtherTAX ID