Provider Demographics
NPI:1801935085
Name:PEARSALL, RONIE RAE (M ED)
Entity type:Individual
Prefix:MRS
First Name:RONIE
Middle Name:RAE
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MT
Mailing Address - Zip Code:59472-9731
Mailing Address - Country:US
Mailing Address - Phone:406-799-5185
Mailing Address - Fax:406-268-7336
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:SUITE 430
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-771-8182
Practice Address - Fax:406-771-3948
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255374Medicaid