| Doctor Name: | NICOLE RENEE ROSS |
| NPI Number: | 1326486879 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 657 Main St Nw Suite 214 Elk River, MN - 553301584 |
| Business Phone Number: | 7632740510 |
| Business Fax Number: | 7634413117 |
| Mailing Address: | 657 Main St Nw, Suite 214 ELK RIVER |
| State: | MN |
| Postal Code: | 553301584 |
| Phone Number: | 7632740510 |
| Fax Number: | 7634413117 |
| NPI Enumeration Date: | 06/06/2013 |
| NPI Last Update Date: | 06/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |