Provider Demographics
NPI:1386762375
Name:ROSS, JO-ANN (MA, CCC)
Entity type:Individual
Prefix:MS
First Name:JO-ANN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5518
Mailing Address - Country:US
Mailing Address - Phone:617-482-3032
Mailing Address - Fax:
Practice Address - Street 1:23 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5518
Practice Address - Country:US
Practice Address - Phone:617-482-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1220OtherSTATE LICENSE