Provider Demographics
NPI:1447472899
Name:BOLKCOM, RONNEY LYNN
Entity type:Individual
Prefix:MRS
First Name:RONNEY
Middle Name:LYNN
Last Name:BOLKCOM
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 1:10709 OLD HWY 99
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:CA
Mailing Address - Zip Code:96038
Mailing Address - Country:US
Mailing Address - Phone:530-430-0115
Mailing Address - Fax:
Practice Address - Street 1:1515 S OREGON ST
Practice Address - Street 2:SUITE A
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-3455
Practice Address - Fax:530-842-7917
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker