Provider Demographics
NPI:1831525963
Name:JUANICO, RONNA
Entity type:Individual
Prefix:MRS
First Name:RONNA
Middle Name:
Last Name:JUANICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17167
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7167
Mailing Address - Country:US
Mailing Address - Phone:601-261-5995
Mailing Address - Fax:601-261-5335
Practice Address - Street 1:2575 PASS RD STE G
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2739
Practice Address - Country:US
Practice Address - Phone:228-385-0361
Practice Address - Fax:228-385-0365
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0618237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist