Healthcare Provider Details

I. General information

NPI: 1609656149
Provider Name (Legal Business Name): CARMEN RYAN LLC, MS, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28925 SW BOBERG RD
WILSONVILLE OR
97070-8218
US

IV. Provider business mailing address

29385 SW TETON WAY
WILSONVILLE OR
97070-8501
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-4602
  • Fax:
Mailing address:
  • Phone: 503-939-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10608
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: