Provider Demographics
NPI:1104149749
Name:SALGE, RONDA J (LCSW)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:J
Last Name:SALGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:J
Other - Last Name:SALGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RMT
Mailing Address - Street 1:PO BOX 8834
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46898-8834
Mailing Address - Country:US
Mailing Address - Phone:260-471-8033
Mailing Address - Fax:260-471-8107
Practice Address - Street 1:1910 SAINT JOE CENTER RD
Practice Address - Street 2:SUITE 44
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-471-8033
Practice Address - Fax:260-471-8107
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006489A1041C0700X, 1041C0700X
225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12308807OtherCAQH
IN201224210AMedicaid
ININ1885001OtherMEDICARE CMS