Provider Demographics
NPI:1528289550
Name:ROSS, AMY LOUISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97634
Mailing Address - Country:US
Mailing Address - Phone:541-891-0897
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN STREET
Practice Address - Street 2:SUITE 209
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-891-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist