MEDICARE: RHONDA L LEDBETTER BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2004030734	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700863917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA L LEDBETTER BA

Provider Business Mailing Address
First Line	:	PO BOX 134
Second Line	:	8429 N HWY 63
City	:	HOUSTON
State	:	MO
Zip	:	65483-0134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1197 HIGHWAY KK
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3344
Country	:	US
Telephone Number	:	573-348-5331
Fax Number	:	573-348-5232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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