Provider Demographics
NPI:1669252359
Name:GALLAWA, RONDA LOIS (MA)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:LOIS
Last Name:GALLAWA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:LOIS
Other - Last Name:FOYT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3615 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1865
Mailing Address - Country:US
Mailing Address - Phone:360-597-6754
Mailing Address - Fax:
Practice Address - Street 1:3615 GRANT ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1865
Practice Address - Country:US
Practice Address - Phone:360-597-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60781909101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional