Healthcare Provider Details

I. General information

NPI: 1841564499
Provider Name (Legal Business Name): RONI PEONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 RESERVATION RD
FORD WA
99013-9700
US

IV. Provider business mailing address

4933 RESERVATION RD
FORD WA
99013-9700
US

V. Phone/Fax

Practice location:
  • Phone: 509-951-0922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC 60254796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: