Provider Demographics
NPI:1194102822
Name:DOCKTER, RHONDA WAAGE (LICSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:WAAGE
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 JAMES RAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-6090
Mailing Address - Country:US
Mailing Address - Phone:701-740-5883
Mailing Address - Fax:
Practice Address - Street 1:4200 JAMES RAY DR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6090
Practice Address - Country:US
Practice Address - Phone:701-740-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND48361041C0700X
MN250511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical