Provider Demographics
NPI:1457170938
Name:RONAN, DADE (MMIS)
Entity type:Individual
Prefix:
First Name:DADE
Middle Name:
Last Name:RONAN
Suffix:
Gender:M
Credentials:MMIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2407
Mailing Address - Country:US
Mailing Address - Phone:316-941-9948
Mailing Address - Fax:
Practice Address - Street 1:3737 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2407
Practice Address - Country:US
Practice Address - Phone:316-941-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral