Healthcare Provider Details

I. General information

NPI: 1750602579
Provider Name (Legal Business Name): SUSAN KAY RYAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 VAN BUREN ST
EUGENE OR
97402-4733
US

IV. Provider business mailing address

1127 VAN BUREN ST
EUGENE OR
97402-4733
US

V. Phone/Fax

Practice location:
  • Phone: 541-914-4602
  • Fax: 541-683-1195
Mailing address:
  • Phone: 541-914-4602
  • Fax: 541-683-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4370
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: