Stephen Gerard Ross, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20040536A Issued in IN

Practice address

4630 W Jefferson Blvd Ste 5
Fort Wayne, IN 46804-6800

Phone

(260) 436-4100

Fax

(260) 432-6282

NPI assigned

Jun 22, 2005

Reactivated

Mar 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1467458695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD STE 5",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046800",
            "telephone_number": "260-436-4100",
            "fax_number": "260-432-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD STE 5",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046800",
            "telephone_number": "260-436-4100",
            "fax_number": "260-432-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "STEPHEN",
        "middle_name": "GERARD",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-04-14",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040536A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean D. Ross, NP
• Jessica Ross, M.A, BCBA
• Jessica Lynn Ross, FNP-C
• Maisie Ross
• Stacy Ross, RN
• Steven Ross, MD
• Helen Catherine Rossman, MS, MSED, NP-C
• Adam Roth, CO
• Daniel Christopher Roth, DO, MBA, MS
• Meredith Roth, PA-C

• Clinical Psychologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.