Provider Demographics
NPI:1780396978
Name:HEARLD, RONALD M
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:HEARLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ELSMERE
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1917
Mailing Address - Country:US
Mailing Address - Phone:859-479-5568
Mailing Address - Fax:
Practice Address - Street 1:925 DUDLEY PIKE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-8120
Practice Address - Country:US
Practice Address - Phone:859-317-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician