Provider Demographics
NPI:1245368315
Name:LETT, RONI KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:RONI
Middle Name:KAY
Last Name:LETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:LETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:128 S 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-543-8415
Mailing Address - Fax:
Practice Address - Street 1:128 S 6TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-543-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSYCH218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0492284Medicaid
MT50941OtherBCBS
MT50941OtherBCBS