Healthcare Provider Details

I. General information

NPI: 1184533929
Provider Name (Legal Business Name): JACQUELYN ELIZABETH ROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CAMBRIDGE BELTWAY DR STE E
CHARLOTTE NC
28273-4351
US

IV. Provider business mailing address

1615 HAWKSTONE DR
WAXHAW NC
28173-7447
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone: 704-635-1901
  • Fax: 704-635-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: