Provider Demographics
NPI:1902904410
Name:RONGEY, JANICE LOUISE (MS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LOUISE
Last Name:RONGEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 ETHERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1108
Mailing Address - Country:US
Mailing Address - Phone:314-963-0659
Mailing Address - Fax:314-965-4711
Practice Address - Street 1:10777 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1019
Practice Address - Country:US
Practice Address - Phone:314-965-2533
Practice Address - Fax:931-496-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01574103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent