Provider Demographics
NPI:1770658338
Name:ROSS, JENNIFER (MCD, CF,SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MCD, CF,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:TYRONZA
Mailing Address - State:AR
Mailing Address - Zip Code:72386-1807
Mailing Address - Country:US
Mailing Address - Phone:870-219-9934
Mailing Address - Fax:
Practice Address - Street 1:1005 BALCOM LN
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9502
Practice Address - Country:US
Practice Address - Phone:870-935-8062
Practice Address - Fax:870-483-6520
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist