Provider Demographics
NPI:1700860483
Name:ROSS, ALAN MAC (AUD/CCC-A)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MAC
Last Name:ROSS
Suffix:
Gender:M
Credentials:AUD/CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 561 BOX 2182
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310-0022
Mailing Address - Country:US
Mailing Address - Phone:254-759-9823
Mailing Address - Fax:
Practice Address - Street 1:PSC 561 BOX 2182
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310-0022
Practice Address - Country:US
Practice Address - Phone:254-759-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51167231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist