Provider Demographics
NPI:1982022711
Name:ROSS, MICHELLE JOY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOY
Last Name:ROSS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 S PLACENTIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:774 S PLACENTIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6826
Practice Address - Country:US
Practice Address - Phone:800-870-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21324235Z00000X
TX106657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist