Healthcare Provider Details

I. General information

NPI: 1891878906
Provider Name (Legal Business Name): JONATHAN ROSS MS CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 BLUEGRASS CIR STE 150
CHEYENNE WY
82009-7362
US

IV. Provider business mailing address

1950 BLUEGRASS CIR STE 150
CHEYENNE WY
82009-7362
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-8224
  • Fax: 307-514-0315
Mailing address:
  • Phone: 307-632-8224
  • Fax: 307-514-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-951
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: