MEDICARE: MS. HEATHER ROSS MSSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I3773	OH

General Provider Information

NPI Number	:	1003824533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER ROSS MSSA

Provider Business Mailing Address
First Line	:	13705 SHAKER BLVD APT 6A
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1507
Country	:	US
Telephone Number	:	216-570-7314
Fax Number	:

Provider Business Practice Location Address
First Line	:	13705 SHAKER BLVD.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1507
Country	:	US
Telephone Number	:	216-570-7314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/15/2024

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