1053625384 NPI number — RHONDA MICHELE KIDNEY LPC

Table of content: RHONDA MICHELE KIDNEY LPC (NPI 1053625384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053625384 NPI number — RHONDA MICHELE KIDNEY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIDNEY
Provider First Name:
RHONDA
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOUDEK
Provider Other First Name:
RHONDA
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053625384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97339-0645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-301-5097
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 NW BUCHANAN AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-6260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-301-5097
Provider Business Practice Location Address Fax Number:
971-345-8015
Provider Enumeration Date:
07/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C5611 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500776565 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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