1407339047 NPI number — MS. JOSIE LEANNE RYAN-PUGH M.S.W.

Table of content: MS. JOSIE LEANNE RYAN-PUGH M.S.W. (NPI 1407339047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407339047 NPI number — MS. JOSIE LEANNE RYAN-PUGH M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN-PUGH
Provider First Name:
JOSIE
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGH
Provider Other First Name:
JOSHUA
Provider Other Middle Name:
LEANDER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407339047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3158 PRINGLE RD SE APT 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302-1686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-621-5796
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-682-7585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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