Provider Demographics
NPI:1124207121
Name:ROSS, BARBARA ANN
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:ROSS
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 1:2121 HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62524
Mailing Address - Country:US
Mailing Address - Phone:217-875-1910
Mailing Address - Fax:217-875-8899
Practice Address - Street 1:2121 HUBBARD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62524
Practice Address - Country:US
Practice Address - Phone:217-875-1910
Practice Address - Fax:217-875-8899
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBR49061004POtherSERVICE COORDINATOR