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General NPI Number Information
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NPI Number | 1003613738
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Entity Type | Individual
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Provider Name | REBECCA ROSS MS, LCGC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3950 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2166
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Country | US
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Telephone | 313-832-9340
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Fax | 313-993-8685
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Provider Business Mailing Address
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Address Line | 1225 MCLEAN AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3494
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Country | US
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Telephone | 248-804-3615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 7201000605
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License Number State | MI
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