Healthcare Provider Details

I. General information

NPI: 1669676128
Provider Name (Legal Business Name): RYAN SEXTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17321 TELEGRAPH RD
DETROIT MI
48219-3132
US

IV. Provider business mailing address

1321 ORLEANS ST APT 1706
DETROIT MI
48207-2908
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059640
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: