Healthcare Provider Details

I. General information

NPI: 1700509007
Provider Name (Legal Business Name): RYAN VANCUREN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 INDIANOLA AVE
COLUMBUS OH
43201-2118
US

IV. Provider business mailing address

636 NEIL AVE
COLUMBUS OH
43215-1610
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2661
  • Fax:
Mailing address:
  • Phone: 440-935-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: