Provider Demographics
NPI:1144472499
Name:ROSCOE, WENDELL A (MASTERS DEGREE)
Entity type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:A
Last Name:ROSCOE
Suffix:
Gender:M
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CAPITOL BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1025
Mailing Address - Country:US
Mailing Address - Phone:402-538-5908
Mailing Address - Fax:402-438-3078
Practice Address - Street 1:1700 S 24TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3003
Practice Address - Country:US
Practice Address - Phone:402-890-2101
Practice Address - Fax:402-488-0361
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health