Basic Information
| Provider Information | |||||||||
| NPI: | 1932785490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | JASWANIQUE | ||||||||
| MiddleName: | DAON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 118 HWY 605 | ||||||||
| Address2: | |||||||||
| City: | NEWELLTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184672366 | ||||||||
| FaxNumber: | 3184672400 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 EE WALLACE BLVD N STE 3 | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713342821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187570016 | ||||||||
| FaxNumber: | 3187570011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.