Provider Demographics
NPI:1003315821
Name:ROSS, WENDOLYN SUEANN (LPC, MFT)
Entity Type:Individual
Prefix:
First Name:WENDOLYN
Middle Name:SUEANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 SYDNEY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9215
Mailing Address - Country:US
Mailing Address - Phone:614-620-5186
Mailing Address - Fax:614-427-0437
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:614-401-4347
Practice Address - Fax:614-427-0437
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700264101YP2500X, 251S00000X
OHM.1800069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist