MEDICARE: CHARISSE HOPPE RYAN LMSW

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	1041C0700X	Clinical Social Worker	6801034955	MI

General Provider Information

NPI Number	:	1255349320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSE HOPPE RYAN LMSW

Provider Business Mailing Address
First Line	:	6549 TOWN CENTER DR STE A
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48346-4824
Country	:	US
Telephone Number	:	248-620-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	31500 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-422-9340
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/17/2018

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