1821180415 NPI number — MS. PATRICIA EILEEN RYAN LCSW

Table of content: DR. NEIL MICHAEL S ESTRELLA M.D. (NPI 1669401030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821180415 NPI number — MS. PATRICIA EILEEN RYAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
PATRICIA
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821180415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 815
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEFISH
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59937-0815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-862-2208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 TAYLOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEFISH
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59937-8419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-212-7016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006

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: 101YM0800X , with the licence number:  LCSW-344 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: LMT 627 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0000070851 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000502749 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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