Provider Demographics
NPI:1174008627
Name:RONDA, ALAN DAVID (SWT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DAVID
Last Name:RONDA
Suffix:
Gender:M
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 COUNTRY TRCE APT 12A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3171
Mailing Address - Country:US
Mailing Address - Phone:419-704-5087
Mailing Address - Fax:
Practice Address - Street 1:701 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6956
Practice Address - Country:US
Practice Address - Phone:419-242-9955
Practice Address - Fax:419-242-8855
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker