Healthcare Provider Details

I. General information

NPI: 1023575644
Provider Name (Legal Business Name): ALYSSA RINGGENBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S KELLY AVE STE C
EDMOND OK
73013-2976
US

IV. Provider business mailing address

2529 S KELLY AVE STE C
EDMOND OK
73013-2976
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-6865
  • Fax: 405-562-1975
Mailing address:
  • Phone: 385-202-6865
  • Fax: 405-562-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10700704-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: