Provider Demographics
NPI:1902099047
Name:POTTER-EFRON, RONALD (MSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:POTTER-EFRON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 HEIGHTS DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4562
Mailing Address - Country:US
Mailing Address - Phone:715-832-8432
Mailing Address - Fax:715-832-5007
Practice Address - Street 1:2125 HEIGHTS DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4562
Practice Address - Country:US
Practice Address - Phone:715-832-8432
Practice Address - Fax:715-832-5007
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2409-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39555000Medicaid
WI0002Medicare PIN