Provider Demographics
NPI:1417006552
Name:HUNTER, RAMONA MARIE (PSYD LP LADC)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:MARIE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PSYD LP LADC
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:M
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:MASH-KA-WISEN
Mailing Address - City:SAWYER
Mailing Address - State:MN
Mailing Address - Zip Code:55780-0066
Mailing Address - Country:US
Mailing Address - Phone:218-879-6731
Mailing Address - Fax:218-879-6734
Practice Address - Street 1:1150 MISSION ROAD
Practice Address - Street 2:MASH-KA-WISEN
Practice Address - City:SAWYER
Practice Address - State:MN
Practice Address - Zip Code:55780-0066
Practice Address - Country:US
Practice Address - Phone:218-879-6731
Practice Address - Fax:218-879-6734
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300080101YA0400X
MNLP4432103T00000X
WI2334057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN271923100Medicaid
MN271923100Medicaid