Provider Demographics
NPI:1831180330
Name:OHLSON, RONALD WINFRED (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WINFRED
Last Name:OHLSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 W 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4114
Mailing Address - Country:US
Mailing Address - Phone:907-563-3162
Mailing Address - Fax:907-248-9962
Practice Address - Street 1:5153 W 80TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4114
Practice Address - Country:US
Practice Address - Phone:907-563-3162
Practice Address - Fax:907-248-9962
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS0121Medicaid
AKPS0121Medicaid