Provider Demographics
NPI:1326775685
Name:ROSS, KENNADIE CHALIS
Entity Type:Individual
Prefix:MISS
First Name:KENNADIE
Middle Name:CHALIS
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 1:925 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-6087
Mailing Address - Country:US
Mailing Address - Phone:910-381-9663
Mailing Address - Fax:
Practice Address - Street 1:925 AVALON DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-6087
Practice Address - Country:US
Practice Address - Phone:910-381-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician