Provider Demographics
NPI:1831342625
Name:VONCANNON, RALPH S (NBC-HIS)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:S
Last Name:VONCANNON
Suffix:
Gender:
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EAST TABERNACLE STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2941
Mailing Address - Country:US
Mailing Address - Phone:435-628-9015
Mailing Address - Fax:435-628-9015
Practice Address - Street 1:415 EAST TABERNACLE STREET
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2941
Practice Address - Country:US
Practice Address - Phone:435-628-9015
Practice Address - Fax:435-628-9015
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT100928-4601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist