Provider Demographics
NPI:1710070271
Name:ROSS, LINDA VANCE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:VANCE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 E FRIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4413
Mailing Address - Country:US
Mailing Address - Phone:602-678-1894
Mailing Address - Fax:602-406-7166
Practice Address - Street 1:124 W THOMAS
Practice Address - Street 2:CHILDREN'S REHABILITATION SERVICE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-6455
Practice Address - Fax:602-406-7166
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical