Provider Demographics
NPI:1093853707
Name:KANE-RONNING, SUSAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:KANE-RONNING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SILVERN LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9412
Mailing Address - Country:US
Mailing Address - Phone:360-714-8109
Mailing Address - Fax:360-756-8936
Practice Address - Street 1:1117 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5203
Practice Address - Country:US
Practice Address - Phone:360-714-8109
Practice Address - Fax:360-756-8936
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001969103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082290Medicaid
WA8918030OtherLABOR AND INDUSTRIES
WA8918030OtherLABOR AND INDUSTRIES