Provider Demographics
NPI:1487704920
Name:BOCK, RONALD EARL (MSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EARL
Last Name:BOCK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WA
Mailing Address - Zip Code:98592-0215
Mailing Address - Country:US
Mailing Address - Phone:360-898-1370
Mailing Address - Fax:
Practice Address - Street 1:310 E DALBY ROAD, SUITE 200
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WA
Practice Address - Zip Code:98592-9611
Practice Address - Country:US
Practice Address - Phone:360-898-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000084021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical