Provider Demographics
NPI:1477643633
Name:CRAFTON, RONALD M (EDD LP)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:CRAFTON
Suffix:
Gender:M
Credentials:EDD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 WEST MAIN ST
Mailing Address - Street 2:WALNUT WOODS CENTRE
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009
Mailing Address - Country:US
Mailing Address - Phone:269-375-5142
Mailing Address - Fax:269-375-4193
Practice Address - Street 1:5955 WEST MAIN ST
Practice Address - Street 2:WALNUT WOODS CENTRE
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-375-5142
Practice Address - Fax:269-375-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM39270Medicare ID - Type Unspecified