Provider Demographics
NPI:1265419196
Name:ROSS, WENDY MICHELE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELE
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 1:1932 ANCLOTE VIS
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-6263
Mailing Address - Country:US
Mailing Address - Phone:727-804-1807
Mailing Address - Fax:727-939-9110
Practice Address - Street 1:1932 ANCLOTE VIS
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-6263
Practice Address - Country:US
Practice Address - Phone:727-804-1807
Practice Address - Fax:727-939-9110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12046452OtherNAT'L CERT. ASHA
FLSA 5791OtherSTATE LICENSE