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General NPI Number Information
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NPI Number | 1881455012
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Entity Type | Organization
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Legal Business Name | JACLYN ROSS PHD PLLC
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 336
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City | CHICAGO
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State | IL
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Zip | 60604-3688
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Country | US
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Telephone | 708-665-4721
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 W SAINT PAUL AVE APT 133
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City | CHICAGO
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State | IL
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Zip | 60647-5343
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Country | US
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Telephone | 908-246-5028
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JACLYN ROSS
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Credential | PHD
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Telephone | 312-210-0374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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