Provider Demographics
NPI:1932785490
Name:ROSS, JASWANIQUE DAON
Entity Type:Individual
Prefix:MS
First Name:JASWANIQUE
Middle Name:DAON
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 1:118 HWY 605
Mailing Address - Street 2:
Mailing Address - City:NEWELLTON
Mailing Address - State:LA
Mailing Address - Zip Code:71357
Mailing Address - Country:US
Mailing Address - Phone:318-467-2366
Mailing Address - Fax:318-467-2400
Practice Address - Street 1:201 EE WALLACE BLVD N STE 3
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2821
Practice Address - Country:US
Practice Address - Phone:318-757-0016
Practice Address - Fax:318-757-0011
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator