Individual
MRS. KELLY MARIE ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS. SLP, CCC
Contact information
Practice address
15802 N. PARKVIEW PLACE, SURPRISE, AZ 85374
(623) 876-7394
Mailing address
5534 W ASTER DR, GLENDALE, AZ 85304-1824
(623) 931-8030
(623) 915-1797
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0312
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
598633
—
AZ
Enumeration date
01/10/2007
Last updated
07/09/2007
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