Provider Demographics
NPI:1447821566
Name:BEATTIE, ROSS ROBERT (MS, LPC-IT)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:ROBERT
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W62N281 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2737
Mailing Address - Country:US
Mailing Address - Phone:414-779-7677
Mailing Address - Fax:
Practice Address - Street 1:W62N281 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2737
Practice Address - Country:US
Practice Address - Phone:414-779-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4976-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional