MEDICARE: MARY ROSS MA, CCC-SLP,L

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	235Z00000X	Speech-Language Pathologist	4210	OH

General Provider Information

NPI Number	:	1235685157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ROSS MA, CCC-SLP,L

Provider Business Mailing Address
First Line	:	5220 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1240
Country	:	US
Telephone Number	:	614-468-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1240
Country	:	US
Telephone Number	:	614-468-8925
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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