Provider Demographics
NPI:1144916024
Name:ROSKE, DANIELLE SUMMER
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SUMMER
Last Name:ROSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2973
Mailing Address - Country:US
Mailing Address - Phone:805-234-1766
Mailing Address - Fax:
Practice Address - Street 1:950 LOS OSOS VALLEY RD STE E
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3248
Practice Address - Country:US
Practice Address - Phone:805-719-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist