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General NPI Number Information
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NPI Number | 1629454855
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Entity Type | Individual
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Provider Name | JORDAN MARIE RYAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 7477 E 46TH PL
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City | TULSA
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State | OK
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Zip | 74145-6305
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Country | US
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Telephone | 918-384-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 19320 E ADMIRAL PL STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3240
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Country | US
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Telephone | 918-340-5503
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Fax | 918-340-5505
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7163
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License Number State | OK
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