Provider Demographics
NPI:1972706430
Name:FANSLOW, RONALD L (MA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:FANSLOW
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 1:150 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-2266
Mailing Address - Country:US
Mailing Address - Phone:989-463-8441
Mailing Address - Fax:
Practice Address - Street 1:150 W CENTER ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-2266
Practice Address - Country:US
Practice Address - Phone:989-463-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68101050961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical