Healthcare Provider Details

I. General information

NPI: 1740217181
Provider Name (Legal Business Name): ROGER PAUL PLAMONDON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 JONES DAIRY RD
JASPER AL
35501-6164
US

IV. Provider business mailing address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-7384
  • Fax: 205-221-7385
Mailing address:
  • Phone: 205-933-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1177
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: