Healthcare Provider Details

I. General information

NPI: 1720203623
Provider Name (Legal Business Name): JANE ROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST MAW SUITE 210
JACKSON MS
39202-2064
US

IV. Provider business mailing address

4239 E RIDGE DR
JACKSON MS
39217-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-973-1697
  • Fax: 601-974-6260
Mailing address:
  • Phone: 601-362-2358
  • Fax: 601-974-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: