Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 16074-132 | WI |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | ||
N | 101YP2500X | Professional Counselor | 7597-125 | WI |
NPI | 1003132473 |
---|---|
Provider Name | Tonyetta L Ross |
First Address | Milwaukee, WI 53221-3830 |
Second Address | Milwaukee, WI 53218-4345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2010 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12088599 | CAQH (01) | WI |