MEDICARE: EMMA 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	235Z00000X	Speech-Language Pathologist	SP.4195	OH

General Provider Information

NPI Number	:	1780051854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA ROSS

Provider Business Mailing Address
First Line	:	1219 HAMPSHIRE HL
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-8634
Country	:	US
Telephone Number	:	937-458-2326
Fax Number	:	937-458-2395

Provider Business Practice Location Address
First Line	:	1728 DAYTON XENIA RD
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-7119
Country	:	US
Telephone Number	:	937-458-2326
Fax Number	:	937-458-2395

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	09/08/2015

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Directions to “ EMMA ROSS ” Practice Location

Language	Start Address	Practice Location

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