MEDICARE: KENNON LASHAWN 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
1	106S00000X	Behavior Technician		DC
2	104100000X	Social Worker		DC

General Provider Information

NPI Number	:	1396609129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNON LASHAWN ROSS

Provider Business Mailing Address
First Line	:	4323 URN ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-5831
Country	:	US
Telephone Number	:	202-826-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	4323 URN ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-5831
Country	:	US
Telephone Number	:	202-826-0125
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ KENNON LASHAWN ROSS ” Practice Location

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