Provider Demographics
NPI:1275258071
Name:THOMAS-ROSS, MICHELLE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:THOMAS-ROSS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-8804
Mailing Address - Country:US
Mailing Address - Phone:515-822-2371
Mailing Address - Fax:
Practice Address - Street 1:2708 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5218
Practice Address - Country:US
Practice Address - Phone:515-957-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical