1104149749 NPI number — RONDA J. SALGE LCSW

Table of content: (NPI 1245418920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104149749 NPI number — RONDA J. SALGE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALGE
Provider First Name:
RONDA
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALGE
Provider Other First Name:
RONDA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104149749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8834
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46898-8834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-471-8033
Provider Business Mailing Address Fax Number:
260-471-8107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 SAINT JOE CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 44
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46825-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-471-8033
Provider Business Practice Location Address Fax Number:
260-471-8107
Provider Enumeration Date:
03/10/2010

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: 1041C0700X , with the licence number:  34006489A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12308807 . This is a "CAQH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201224210A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: IN1885001 . This is a "MEDICARE CMS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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