Provider Demographics
NPI:1265970560
Name:ROSS, MEGAN R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13705 RIDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9464
Mailing Address - Country:US
Mailing Address - Phone:260-515-9814
Mailing Address - Fax:
Practice Address - Street 1:6039 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4410
Practice Address - Country:US
Practice Address - Phone:260-515-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006486A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical