Healthcare Provider Details

I. General information

NPI: 1922372184
Provider Name (Legal Business Name): RONALD JAMES HENDERSON M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RON JAMES HENDERSON

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 16TH ST
NORTH BEND OR
97459-2625
US

IV. Provider business mailing address

1913 MEADE ST
NORTH BEND OR
97459-3432
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-1942
  • Fax:
Mailing address:
  • Phone: 541-756-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: