Healthcare Provider Details

I. General information

NPI: 1982915419
Provider Name (Legal Business Name): SUSANNA HUMBARD RONGEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE HUMBARD RONGEY LCSW

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S PROMENADE BLVD
ROGERS AR
72758-9073
US

IV. Provider business mailing address

3600 S NATIONAL AVE
SPRINGFIELD MO
65807-7311
US

V. Phone/Fax

Practice location:
  • Phone: 479-427-7722
  • Fax: 417-350-1935
Mailing address:
  • Phone: 417-322-6622
  • Fax: 417-350-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number916-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR49764
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: