Provider Demographics
NPI:1003001744
Name:WALDEN, RONNY ALAN
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:ALAN
Last Name:WALDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 SHELLEY LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1444
Mailing Address - Country:US
Mailing Address - Phone:206-514-4904
Mailing Address - Fax:
Practice Address - Street 1:2416 SHELLEY LN
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1444
Practice Address - Country:US
Practice Address - Phone:206-514-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health