Provider Demographics
NPI:1033874474
Name:ROSS, KENDRA N (BA, QMHS)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:N
Last Name:ROSS
Suffix:
Gender:F
Credentials:BA, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 KNOLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1525
Mailing Address - Country:US
Mailing Address - Phone:216-260-1405
Mailing Address - Fax:330-632-8823
Practice Address - Street 1:850 HOWLAND WILSON RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2116
Practice Address - Country:US
Practice Address - Phone:216-260-1405
Practice Address - Fax:330-632-8823
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 106S00000X, 172V00000X
OH1033874474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician