Provider Demographics
NPI:1568943173
Name:ROSS, TRICIA DANIELLE (MA, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:DANIELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ATKINS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4411
Mailing Address - Country:US
Mailing Address - Phone:347-322-9986
Mailing Address - Fax:
Practice Address - Street 1:2944 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3443
Practice Address - Country:US
Practice Address - Phone:718-647-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist