Basic Information
| Provider Information | |||||||||
| NPI: | 1063416519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROESER | ||||||||
| FirstName: | ROSS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1921 MARYDALE DR | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752083034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149053001 | ||||||||
| FaxNumber: | 2149053022 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S TOOL DR | ||||||||
| Address2: | |||||||||
| City: | KEMP | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751431959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034321932 | ||||||||
| FaxNumber: | 9034321943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.