MEDICARE: MR. DALE G. ROSS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1976405	MI

General Provider Information

NPI Number	:	1942406491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE G. ROSS MSW

Provider Business Mailing Address
First Line	:	28475 GREENFIELD RD
Second Line	:	SUITE 206
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-3034
Country	:	US
Telephone Number	:	248-544-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	28475 GREENFIELD RD
Second Line	:	SUITE 206
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-3034
Country	:	US
Telephone Number	:	248-544-7041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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