Provider Demographics
NPI:1922372184
Name:HENDERSON, RONALD JAMES (MA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:RON
Other - Middle Name:JAMES
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1913 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3432
Mailing Address - Country:US
Mailing Address - Phone:541-756-4508
Mailing Address - Fax:
Practice Address - Street 1:1500 16TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2625
Practice Address - Country:US
Practice Address - Phone:541-756-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool