Provider Demographics
NPI:1619482171
Name:DEAN, RONALD JAMES (SLP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:HENNEPIN
Mailing Address - State:IL
Mailing Address - Zip Code:61327-5061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND RIDGE
Practice Address - State:IL
Practice Address - Zip Code:61325-9687
Practice Address - Country:US
Practice Address - Phone:815-249-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist