Healthcare Provider Details

I. General information

NPI: 1669252359
Provider Name (Legal Business Name): RONDA LOIS GALLAWA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RONDA LOIS FOYT MA

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 GRANT ST
VANCOUVER WA
98660-1865
US

IV. Provider business mailing address

3615 GRANT ST
VANCOUVER WA
98660-1865
US

V. Phone/Fax

Practice location:
  • Phone: 360-597-6754
  • Fax:
Mailing address:
  • Phone: 360-597-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60781909
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60781909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: