Provider Demographics
NPI:1326181736
Name:HORNER ROSS, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:HORNER 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 1:1305 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3138
Mailing Address - Country:US
Mailing Address - Phone:701-572-2421
Mailing Address - Fax:
Practice Address - Street 1:1415 W DAKOTA PKWY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3885
Practice Address - Country:US
Practice Address - Phone:701-572-6757
Practice Address - Fax:701-774-3532
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist