Provider Demographics
NPI:1881872141
Name:DIEGEL, RONDA PRETZLAFF (PHD)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:PRETZLAFF
Last Name:DIEGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N POND DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3080
Mailing Address - Country:US
Mailing Address - Phone:248-730-0597
Mailing Address - Fax:248-669-1924
Practice Address - Street 1:55 N POND DR
Practice Address - Street 2:SUITE 6
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3080
Practice Address - Country:US
Practice Address - Phone:248-730-0597
Practice Address - Fax:248-669-1924
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical