MEDICARE: RYAN ANTHONY MARLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	PSW1398	FL
2	1041C0700X	Clinical Social Worker	LW61508432	WA

General Provider Information

NPI Number	:	1063988327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ANTHONY MARLER

Provider Business Mailing Address
First Line	:	522 W RIVERSIDE AVE STE N
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0580
Country	:	US
Telephone Number	:	904-412-5405
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 DANFORTH DR APT 604
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5255
Country	:	US
Telephone Number	:	904-412-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	07/26/2024

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