Provider Demographics
NPI:1104242684
Name:ROSS, JENNIFER (CSA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA
Mailing Address - Street 1:6082 STONEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1215
Mailing Address - Country:US
Mailing Address - Phone:440-371-7976
Mailing Address - Fax:
Practice Address - Street 1:6082 STONEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1215
Practice Address - Country:US
Practice Address - Phone:440-371-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant