Provider Demographics
NPI:1386309383
Name:ROIKO, KELLYN (LCSW)
Entity type:Individual
Prefix:
First Name:KELLYN
Middle Name:
Last Name:ROIKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 VOYAGER CV
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6417
Mailing Address - Country:US
Mailing Address - Phone:719-291-6099
Mailing Address - Fax:
Practice Address - Street 1:304 VOYAGER CV
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6417
Practice Address - Country:US
Practice Address - Phone:719-291-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066531041C0700X
COCSW.099297501041C0700X
IA1232751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical