Provider Demographics
NPI:1255636387
Name:RONNING-DICKSON, LISA MICHELLE (ED, M, MHP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:RONNING-DICKSON
Suffix:
Gender:F
Credentials:ED, M, MHP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:RONNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 SWIFT BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-792-0277
Mailing Address - Fax:
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-792-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60258554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health