Provider Demographics
NPI:1932898525
Name:ROBERTS, JO-ELLEN ROSS (CRADC, SQP)
Entity Type:Individual
Prefix:
First Name:JO-ELLEN
Middle Name:ROSS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRADC, SQP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65667-8102
Mailing Address - Country:US
Mailing Address - Phone:471-259-7612
Mailing Address - Fax:
Practice Address - Street 1:121 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:MO
Practice Address - Zip Code:65667-8102
Practice Address - Country:US
Practice Address - Phone:471-259-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5637101YA0400X
MO3186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)