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General NPI Number Information
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NPI Number | 1003315771
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Entity Type | Individual
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Provider Name | JEANNE NORGREN RYAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 114 SLOAN ST
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City | ROSWELL
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State | GA
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Zip | 30075-4922
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Country | US
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Telephone | 770-594-3065
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Fax | 770-594-3099
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Provider Business Mailing Address
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Address Line | 335 INMAN PL
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City | ROSWELL
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State | GA
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Zip | 30075-6853
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Country | US
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Telephone | 770-367-3848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2081
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004153
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License Number State | GA
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