Provider Demographics
NPI:1932473097
Name:RONDEAU, GRACE (LPC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:RONDEAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:GRACIELA
Other - Last Name:RONDEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 7TH ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1222
Practice Address - Country:US
Practice Address - Phone:262-634-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3168-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional