Provider Demographics
NPI:1427218585
Name:RINGDAHL, JOEL ERIC (PHD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ERIC
Last Name:RINGDAHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500C S LEWIS LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3448
Mailing Address - Country:US
Mailing Address - Phone:618-453-8295
Mailing Address - Fax:618-453-6386
Practice Address - Street 1:500C S LEWIS LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3448
Practice Address - Country:US
Practice Address - Phone:618-453-8295
Practice Address - Fax:618-453-6386
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01017103T00000X
IL1-12-12128103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923107Medicare PIN