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NPI Code Detail

MEDICARE: RONDA NIEDERHAUSER PHD

MEDICARE:   RONDA  NIEDERHAUSER  PHD
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
1103TC0700XClinical Psychologist576NE
2103TC0700XClinical Psychologist3109CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1680015705OTHERRR MEDICARE

General Provider Information

NPI Number : 1891887840
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONDA NIEDERHAUSER PHD
Provider Business Mailing Address
First Line : 7920 CALLENDALE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80908-5028
Country : US
Telephone Number : 719-205-9517
Fax Number :
Provider Business Practice Location Address
First Line : 1650 COCHRANE CIR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80913-4613
Country : US
Telephone Number : 719-524-6024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 02/22/2024

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