Healthcare Provider Details

I. General information

NPI: 1942027529
Provider Name (Legal Business Name): JASON A ROSS LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W OAK ST STE 203
MASON MI
48854-1763
US

IV. Provider business mailing address

619 S ROGERS ST
MASON MI
48854-1737
US

V. Phone/Fax

Practice location:
  • Phone: 517-803-0846
  • Fax:
Mailing address:
  • Phone: 517-851-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118944
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: