Provider Demographics
NPI:1609153592
Name:BRECKENRIDGE, RHONDA LEEANN (LICSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEEANN
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:LEEANN
Other - Last Name:BARSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1007 KOALA DR
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9247
Mailing Address - Country:US
Mailing Address - Phone:509-826-8409
Mailing Address - Fax:509-826-3029
Practice Address - Street 1:1007 KOALA DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9247
Practice Address - Country:US
Practice Address - Phone:509-826-6191
Practice Address - Fax:509-826-3029
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602435171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090983Medicaid