Provider Demographics
NPI:1265080931
Name:RONNING, SHANDRA LYNN
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:LYNN
Last Name:RONNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1926
Mailing Address - Country:US
Mailing Address - Phone:253-891-6000
Mailing Address - Fax:
Practice Address - Street 1:1202 WOOD AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1926
Practice Address - Country:US
Practice Address - Phone:253-891-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant