Provider Demographics
NPI:1699203232
Name:ROYER, RONALD CHARLES
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:ROYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2842
Mailing Address - Country:US
Mailing Address - Phone:218-844-5782
Mailing Address - Fax:218-844-5799
Practice Address - Street 1:811 8TH ST SE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2842
Practice Address - Country:US
Practice Address - Phone:218-844-5782
Practice Address - Fax:218-844-5799
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1086101YP2500X
MN303423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1992179356Medicaid