Healthcare Provider Details

I. General information

NPI: 1013827476
Provider Name (Legal Business Name): ROSS LAWRENCE HARFORD MSE SCHOOL COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

333 E SLIFER ST
PORTAGE WI
53901-1259
US

IV. Provider business mailing address

333 E SLIFER ST
PORTAGE WI
53901-1259
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-3494
  • Fax:
Mailing address:
  • Phone: 608-742-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3001031362
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: