Provider Demographics
NPI:1649444290
Name:KNUDSEN, RONDA SUE (LPC)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:SUE
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6126
Mailing Address - Country:US
Mailing Address - Phone:208-523-0787
Mailing Address - Fax:208-523-3175
Practice Address - Street 1:1277 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6126
Practice Address - Country:US
Practice Address - Phone:208-523-0787
Practice Address - Fax:208-523-3175
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 2671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health