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General NPI Number Information
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NPI Number | 1194505875
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Entity Type | Individual
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Provider Name | JENNA MARIE RYCEK ED.S.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 5499 OLD LOGAN RD
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City | LOGAN
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State | WV
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Zip | 25601-3072
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Country | US
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Telephone | 308-627-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 5499 OLD LOGAN RD
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City | LOGAN
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State | WV
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Zip | 25601-3072
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Country | US
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Telephone | 308-627-4711
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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 | 3247486526
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | J3N148200276
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License Number State | WV
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