Provider Demographics
NPI:1568550598
Name:CONLIN, RONALD JAMES (MS CCC-A)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:CONLIN
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4415
Mailing Address - Country:US
Mailing Address - Phone:208-232-3131
Mailing Address - Fax:208-233-8351
Practice Address - Street 1:804 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4415
Practice Address - Country:US
Practice Address - Phone:208-232-3131
Practice Address - Fax:208-233-8351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA 384237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter