Provider Demographics
NPI:1750659140
Name:ROSS, MARY H
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
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 1:410 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6781
Mailing Address - Country:US
Mailing Address - Phone:207-783-9443
Mailing Address - Fax:207-777-6020
Practice Address - Street 1:410 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6781
Practice Address - Country:US
Practice Address - Phone:207-783-9443
Practice Address - Fax:207-777-6020
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME286237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist