Provider Demographics
NPI:1861463440
Name:RIDDER, RONALD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:RIDDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-369-4777
Mailing Address - Fax:319-369-4694
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-369-4777
Practice Address - Fax:319-369-4694
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPHD338103TC0700X
IA080046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1614001OtherINDIVIDUAL PTAN
NE10025567800Medicaid
NE10025845100Medicaid
NENA1614OtherPTAN GROUP
NE10025845100Medicaid