Provider Demographics
NPI:1033419189
Name:SASSO, RON (NCC, LPC,CBIST)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:SASSO
Suffix:
Gender:M
Credentials:NCC, LPC,CBIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 SOO SAN DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3142
Mailing Address - Country:US
Mailing Address - Phone:605-718-8446
Mailing Address - Fax:605-721-9858
Practice Address - Street 1:803 SOO SAN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3142
Practice Address - Country:US
Practice Address - Phone:605-718-8446
Practice Address - Fax:605-721-9858
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1104101YP2500X
NCC - 46969101YP2500X
CBIST - 6578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist