Provider Demographics
NPI:1609913839
Name:ANDERSON, RONALD (MS, NCC, PC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS, NCC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FALL ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3157
Mailing Address - Country:US
Mailing Address - Phone:715-524-4840
Mailing Address - Fax:715-524-4236
Practice Address - Street 1:601 FALL ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3157
Practice Address - Country:US
Practice Address - Phone:715-524-4840
Practice Address - Fax:715-524-4236
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2211-1251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39214500Medicaid