Healthcare Provider Details

I. General information

NPI: 1134948326
Provider Name (Legal Business Name): ISABEL RUTH RYZENGA LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HIGHLAND RD STE C
WATERFORD MI
48328-2162
US

IV. Provider business mailing address

23761 EASTERLING AVE
HAZEL PARK MI
48030-1434
US

V. Phone/Fax

Practice location:
  • Phone: 248-721-9335
  • Fax:
Mailing address:
  • Phone: 616-594-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851117410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: