Provider Demographics
NPI:1235703927
Name:NELSON, RONALD STANLEY (DOCTOR CMC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:STANLEY
Last Name:NELSON
Suffix:
Gender:M
Credentials:DOCTOR CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 W STALEY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9714
Mailing Address - Country:US
Mailing Address - Phone:509-312-9875
Mailing Address - Fax:
Practice Address - Street 1:4006 W STALEY RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-9714
Practice Address - Country:US
Practice Address - Phone:509-312-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral