Provider Demographics
NPI:1942202734
Name:WILLMOT, RONDA LOREEN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:LOREEN
Last Name:WILLMOT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1827
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:
Practice Address - Street 1:1014 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1849
Practice Address - Country:US
Practice Address - Phone:970-213-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORR671485OtherBLUE CROSS/ BLUE SHIELD
CO753173666-01OtherPACIFICARE
CO07002918Medicaid
CO22286223Medicaid
CO07002918Medicaid
CORR671485OtherBLUE CROSS/ BLUE SHIELD
CO753173666Medicare UPIN