Provider Demographics
NPI:1063042760
Name:CARLSON, RONDA (AAS-HIS)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:AAS-HIS
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR STE 212
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-3932
Mailing Address - Fax:253-851-4216
Practice Address - Street 1:1901 S 72ND ST # A14
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1200
Practice Address - Country:US
Practice Address - Phone:253-473-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00004508237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist