Provider Demographics
NPI:1811296767
Name:ROSS, SHAWNIKA
Entity type:Individual
Prefix:
First Name:SHAWNIKA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19300 RINALDI ST
Mailing Address - Street 2:# 8270
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1651
Mailing Address - Country:US
Mailing Address - Phone:562-343-5800
Mailing Address - Fax:
Practice Address - Street 1:912 E 103RD PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3239
Practice Address - Country:US
Practice Address - Phone:323-381-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor