Healthcare Provider Details

I. General information

NPI: 1528012481
Provider Name (Legal Business Name): RONALD ALAN POWELL MSW LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

IV. Provider business mailing address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-7284
  • Fax: 765-935-5002
Mailing address:
  • Phone: 765-935-7284
  • Fax: 765-935-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: