Provider Demographics
NPI:1437291002
Name:DEAVOURS, ROSS SOWELL (AUD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:SOWELL
Last Name:DEAVOURS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 BIENVILLE BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3067
Mailing Address - Country:US
Mailing Address - Phone:228-818-9555
Mailing Address - Fax:228-875-7493
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3067
Practice Address - Country:US
Practice Address - Phone:228-818-9555
Practice Address - Fax:228-875-7493
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2055231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02828093Medicaid
MS02828093Medicaid