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General NPI Number Information
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NPI Number | 1073119632
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Entity Type | Individual
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Provider Name | KRISTEN RYDER SSP, LLMSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 333 W GRANDVIEW PKWY STE 403
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2298
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Country | US
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Telephone | 231-929-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 2632 CROSSING CIR # 1012
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7930
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Country | US
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Telephone | 231-268-0208
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SP0000000792258
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License Number State | MI
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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 | 6851117943
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License Number State | MI
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