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Individual

IRIS FAE ROSS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, L.P.C.

Contact information

Practice address
110 N. SECOND ST., ELLINGTON, MO 63638
(573) 663-2988
(573) 663-3431
Mailing address
RT 4 BOX 4264, PIEDMONT, MO 63957
(573) 856-4991
(573) 663-3431

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001830
MO

Other

Enumeration date
04/11/2007
Last updated
07/08/2007
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