Provider Demographics
NPI:1073851655
Name:MOORE, RONDA DENISE (APSW)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:DENISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8532 W CAPITOL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1848
Mailing Address - Country:US
Mailing Address - Phone:414-435-1115
Mailing Address - Fax:414-435-0543
Practice Address - Street 1:8532 W CAPITOL DR
Practice Address - Street 2:200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1848
Practice Address - Country:US
Practice Address - Phone:414-435-1115
Practice Address - Fax:414-435-0435
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128885-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker