Provider Demographics
NPI:1629139019
Name:REITZ, RONDA REDDEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:REDDEN
Last Name:REITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 KINGSTON PIKE
Mailing Address - Street 2:#410
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5022
Mailing Address - Country:US
Mailing Address - Phone:865-382-2747
Mailing Address - Fax:865-584-4865
Practice Address - Street 1:5401 KINGSTON PIKE
Practice Address - Street 2:#410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5022
Practice Address - Country:US
Practice Address - Phone:865-382-2747
Practice Address - Fax:865-584-4865
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002299103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4037983OtherBLUE CROSS BLUE SHIELD