Healthcare Provider Details

I. General information

NPI: 1861911547
Provider Name (Legal Business Name): JONATHEN ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E. WASHINGTON ST., STE 100A
ANN ARBOR MI
48104
US

IV. Provider business mailing address

500 E WASHINGTON ST STE 100A
ANN ARBOR MI
48104-2057
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-3471
  • Fax: 734-764-8128
Mailing address:
  • Phone: 734-764-3471
  • Fax: 734-764-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101375
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: