1497068092 NPI number — WENDY A RYAN LCSW

Table of content: WENDY A RYAN LCSW (NPI 1497068092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497068092 NPI number — WENDY A RYAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
WENDY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYAN, LCSW, LLC
Provider Other First Name:
WENDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497068092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 E HORIZON DR
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89015-8035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-293-2696
Provider Business Mailing Address Fax Number:
702-475-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 E HORIZON DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89015-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-293-2696
Provider Business Practice Location Address Fax Number:
702-475-8220
Provider Enumeration Date:
07/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6329-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497068092 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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