Provider Demographics
NPI:1134639842
Name:CLEWETT VON RONNE, MARJORIE (MA, CMP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:CLEWETT VON RONNE
Suffix:
Gender:F
Credentials:MA, CMP
Other - Prefix:
Other - First Name:MARDI
Other - Middle Name:
Other - Last Name:STORM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:107 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1811
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:
Practice Address - Street 1:107 W 11TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-399-2923
Practice Address - Fax:970-874-4169
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 101YM0800X
CA67086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist