Provider Demographics
NPI:1891428207
Name:STEVENS, RONDA (LMFT)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3977
Mailing Address - Country:US
Mailing Address - Phone:763-772-2888
Mailing Address - Fax:
Practice Address - Street 1:2495 CLEAR BROOK CIR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-3977
Practice Address - Country:US
Practice Address - Phone:763-772-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist