Provider Demographics
NPI:1679230833
Name:ROSS, JESSICA LEIGH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
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 1:7213 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3462
Mailing Address - Country:US
Mailing Address - Phone:978-732-8621
Mailing Address - Fax:
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4991
Practice Address - Country:US
Practice Address - Phone:978-732-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist