Healthcare Provider Details

I. General information

NPI: 1396609129
Provider Name (Legal Business Name): KENNON LASHAWN ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 URN ST
CAPITOL HEIGHTS MD
20743-5831
US

IV. Provider business mailing address

4323 URN ST
CAPITOL HEIGHTS MD
20743-5831
US

V. Phone/Fax

Practice location:
  • Phone: 202-826-0125
  • Fax:
Mailing address:
  • Phone: 202-826-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: