Provider Demographics
NPI:1275956880
Name:VANAUSDAL, RON (LCSW)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:VANAUSDAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16204 BECKLEY CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8340
Mailing Address - Country:US
Mailing Address - Phone:208-602-1364
Mailing Address - Fax:
Practice Address - Street 1:702 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3121
Practice Address - Country:US
Practice Address - Phone:541-889-9167
Practice Address - Fax:541-889-7873
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-357111041C0700X
ORL70361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical