Healthcare Provider Details

I. General information

NPI: 1851197354
Provider Name (Legal Business Name): JESSICA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CROWN POINT CIR STE 125
GRASS VALLEY CA
95945-9538
US

IV. Provider business mailing address

333 CROWN POINT CIR STE 125
GRASS VALLEY CA
95945-9538
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax: 530-273-5479
Mailing address:
  • Phone: 530-273-5440
  • Fax: 530-273-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: