Individual
TONYETTA L ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
5330 W VILLARD AVE, MILWAUKEE, WI 53218-4345
(414) 488-6291
(414) 488-6293
Mailing address
1711 W CLAYTON CREST AVE, MILWAUKEE, WI 53221-3830
(414) 690-0672
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
16074-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
7597-125
WI
101YP2500X
Professional Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12088599
CAQH
WI
Enumeration date
04/10/2010
Last updated
12/12/2019
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