Provider Demographics
NPI:1558599167
Name:BUCKLEY, RONIE R (ST)
Entity Type:Individual
Prefix:
First Name:RONIE
Middle Name:R
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-7909
Mailing Address - Country:US
Mailing Address - Phone:734-240-9670
Mailing Address - Fax:734-240-9671
Practice Address - Street 1:610 W ELM AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7909
Practice Address - Country:US
Practice Address - Phone:734-240-9670
Practice Address - Fax:734-240-9671
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist