Provider Demographics
NPI:1235685157
Name:ROSS, MARY (MA, CCC-SLP,L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, CCC-SLP,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1240
Mailing Address - Country:US
Mailing Address - Phone:614-468-8925
Mailing Address - Fax:
Practice Address - Street 1:5220 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1240
Practice Address - Country:US
Practice Address - Phone:614-468-8925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist