Provider Demographics
NPI:1417253378
Name:ROSS, LELAND HERMAN (MSW)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:HERMAN
Last Name:ROSS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 VERNON WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5334
Mailing Address - Country:US
Mailing Address - Phone:541-206-1301
Mailing Address - Fax:
Practice Address - Street 1:499 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2505
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health