Provider Demographics
NPI:1881703858
Name:BOARDWAY, RONALD HAROLD (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HAROLD
Last Name:BOARDWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 E 10 MILE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-4412
Mailing Address - Country:US
Mailing Address - Phone:586-776-3666
Mailing Address - Fax:586-776-3369
Practice Address - Street 1:19900 E 10 MILE RD STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-4412
Practice Address - Country:US
Practice Address - Phone:586-776-3666
Practice Address - Fax:586-776-3369
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB008826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical