Provider Demographics
NPI:1679514533
Name:RONALD, LINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:RONALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:RONALD
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0792
Mailing Address - Country:US
Mailing Address - Phone:765-962-2014
Mailing Address - Fax:
Practice Address - Street 1:238 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5412
Practice Address - Country:US
Practice Address - Phone:765-962-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010262A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI002359OtherCHAMPUS