Healthcare Provider Details

I. General information

NPI: 1750307930
Provider Name (Legal Business Name): JANET ELAINE RYDER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W VETERANS BLVD ROOM 434
BIG SPRING TX
79720-5566
US

IV. Provider business mailing address

300 W VETERANS BLVD ROOM 434
BIG SPRING TX
79720-5566
US

V. Phone/Fax

Practice location:
  • Phone: 432-263-7361
  • Fax: 432-268-5086
Mailing address:
  • Phone: 432-263-7361
  • Fax: 432-268-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW39560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: