Provider Demographics
NPI:1821489733
Name:ROSS, REBECCA WILLIAMS (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:WILLIAMS
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3441
Mailing Address - Country:US
Mailing Address - Phone:937-296-0304
Mailing Address - Fax:
Practice Address - Street 1:26 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-3441
Practice Address - Country:US
Practice Address - Phone:937-296-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1165203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist