Provider Demographics
NPI:1548389091
Name:RARDIN, DONALD ROGER (PH D)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ROGER
Last Name:RARDIN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHWAY 150 SOUTH
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-0177
Mailing Address - Country:US
Mailing Address - Phone:307-789-3464
Mailing Address - Fax:307-789-5277
Practice Address - Street 1:HIGHWAY 150 SOUTH
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82931-0177
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:307-789-5277
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY96103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical