Provider Demographics
NPI:1487955779
Name:ROSS, ANN HADDOCK (LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:HADDOCK
Last Name:ROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHESTNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4900
Mailing Address - Country:US
Mailing Address - Phone:314-494-7012
Mailing Address - Fax:314-764-2006
Practice Address - Street 1:17 CHESTNUT HILL LN
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-4900
Practice Address - Country:US
Practice Address - Phone:314-494-7012
Practice Address - Fax:314-764-2006
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional