Provider Demographics
NPI:1861893505
Name:DISCH, RONDA MARIE
Entity type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:MARIE
Last Name:DISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:657 MAIN ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1584
Mailing Address - Country:US
Mailing Address - Phone:763-333-8001
Mailing Address - Fax:
Practice Address - Street 1:11090 183RD CIR NW STE C
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2884
Practice Address - Country:US
Practice Address - Phone:763-333-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health