Provider Demographics
NPI:1134697790
Name:ROSS, DONNA SATTERLEE (BCBA, MED)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SATTERLEE
Last Name:ROSS
Suffix:
Gender:F
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:9559 HIGHWAY 5 STE 601
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1572
Practice Address - Country:US
Practice Address - Phone:470-632-5276
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-31589103K00000X
MS180064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-31589OtherBEHAVIOR ANALYST CERTIFICATION BOARD
MS180064OtherMISSISSIPPI BOARD OF AUTISM