Healthcare Provider Details

I. General information

NPI: 1730708934
Provider Name (Legal Business Name): KATHRYN MARIE ROSS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100165
GAINESVILLE FL
32610-3001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0294
  • Fax: 352-627-4889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: