Healthcare Provider Details

I. General information

NPI: 1043261951
Provider Name (Legal Business Name): STEPHANIE ANNE ROSS PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: STEPHANIE ANNE ROSS PH.D

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST SUITE 800
EVANSTON IL
60201-1777
US

IV. Provider business mailing address

3633 W LAKE AVE SUITE 400
GLENVIEW IL
60026-5805
US

V. Phone/Fax

Practice location:
  • Phone: 773-459-6756
  • Fax: 773-728-8719
Mailing address:
  • Phone: 773-459-6759
  • Fax: 773-728-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: