Individual
THERESA L. ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
777 HOSPITAL WAY, SUITE G11, POCATELLO, ID 83201-5175
(208) 239-1710
(208) 239-1713
Mailing address
777 HOSPITAL WAY, SUITE G11, POCATELLO, ID 83201-5175
(208) 239-1710
(208) 239-1713
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY202084
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807126900
—
ID
Enumeration date
01/04/2007
Last updated
09/18/2013
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