Provider Demographics
NPI:1124003322
Name:ALTHAGE, RHONDA S (MA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:ALTHAGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:S
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 E SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1361
Mailing Address - Country:US
Mailing Address - Phone:314-541-9930
Mailing Address - Fax:
Practice Address - Street 1:13160 COUNTY RD 3610
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-2508
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003006346101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496041625Medicaid