Provider Demographics
NPI:1013641760
Name:ROSS, CELIA RAE (MSED, LPC-IT)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:RAE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSED, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3417
Mailing Address - Country:US
Mailing Address - Phone:218-260-1801
Mailing Address - Fax:
Practice Address - Street 1:3215 TOWER AVE STE 108
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5328
Practice Address - Country:US
Practice Address - Phone:715-718-5606
Practice Address - Fax:715-718-5607
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7016-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health