Provider Demographics
NPI:1902207657
Name:ROSS, RENDA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENDA
Middle Name:ANN
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 1:7140 N HIGH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2330
Mailing Address - Country:US
Mailing Address - Phone:614-306-3338
Mailing Address - Fax:614-236-6822
Practice Address - Street 1:7140 N HIGH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2330
Practice Address - Country:US
Practice Address - Phone:614-306-3338
Practice Address - Fax:614-236-6822
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 51981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical