Provider Demographics
NPI:1972157378
Name:ROSS, CATHERINE LEATRICE (AUD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LEATRICE
Last Name:ROSS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 SAM PAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7555
Mailing Address - Country:US
Mailing Address - Phone:903-746-8072
Mailing Address - Fax:
Practice Address - Street 1:409 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2069
Practice Address - Country:US
Practice Address - Phone:817-261-9191
Practice Address - Fax:817-468-2724
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81193231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist