Provider Demographics
NPI:1932278041
Name:NELSON, RONALD (LPHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 EDGEWOOD RD NW
Mailing Address - Street 2:STE 202
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-4472
Mailing Address - Country:US
Mailing Address - Phone:319-393-5004
Mailing Address - Fax:319-393-5004
Practice Address - Street 1:222 EDGEWOOD RD NW
Practice Address - Street 2:STE 202
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4472
Practice Address - Country:US
Practice Address - Phone:319-393-5004
Practice Address - Fax:319-393-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00386103T00000X
IA89103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist