Provider Demographics
NPI:1942800073
Name:WILCOXSON, RONALD LEE (MA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEE
Last Name:WILCOXSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2940
Mailing Address - Country:US
Mailing Address - Phone:303-880-9030
Mailing Address - Fax:
Practice Address - Street 1:2490 W 26TH AVE STE 120A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5317
Practice Address - Country:US
Practice Address - Phone:303-925-4580
Practice Address - Fax:303-925-4580
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0001081101YP2500X
CO1081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health