MEDICARE: MR. RONALD MARK LINGLE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PS006004L	PA

General Provider Information

NPI Number	:	1831295351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD MARK LINGLE MA

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	HYDE
State	:	PA
Zip	:	16843-0012
Country	:	US
Telephone Number	:	814-765-6941
Fax Number	:	814-765-6941

Provider Business Practice Location Address
First Line	:	109 E LOCUST ST
Second Line	:
City	:	CLEARFIELD
State	:	PA
Zip	:	16830-2412
Country	:	US
Telephone Number	:	814-765-6941
Fax Number	:	814-765-6941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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