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NPI Code Detail

MEDICARE: REBECCA ROSS

MEDICARE: REBECCA ROSS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor18130130WI

General Provider Information

NPI Number : 1225561269
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ROSS
Provider Business Mailing Address
First Line : PO 04188
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5235 N IRONWOOD RD
Second Line :
City : GLENDALE
State : WI
Zip : 53217-4906
Country : US
Telephone Number : 414-902-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2017
Last Update Date : 04/06/2017

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Directions to “ REBECCA ROSS ” Practice Location

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