Provider Demographics
NPI:1609990753
Name:ROSS, LENA SLATER
Entity Type:Individual
Prefix:MRS
First Name:LENA
Middle Name:SLATER
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LENA
Other - Middle Name:SLATER
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2480 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4728
Mailing Address - Country:US
Mailing Address - Phone:586-596-2321
Mailing Address - Fax:
Practice Address - Street 1:24715 LITTLE MACK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3207
Practice Address - Country:US
Practice Address - Phone:586-779-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09460018Medicare PIN