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General NPI Number Information
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NPI Number | 1932898525
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Entity Type | Individual
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Provider Name | JO-ELLEN ROSS ROBERTS CRADC, SQP
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 121 N CHURCH ST
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City | HARTVILLE
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State | MO
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Zip | 65667-8102
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Country | US
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Telephone | 471-259-7612
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N CHURCH ST
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City | HARTVILLE
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State | MO
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Zip | 65667-8102
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Country | US
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Telephone | 471-259-7612
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5637
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3186
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License Number State | MO
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