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General NPI Number Information
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NPI Number | 1831328079
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Entity Type | Individual
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Provider Name | CELESTE RYANE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 843 E MAIN ST STE 208
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City | MEDFORD
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State | OR
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Zip | 97504-7137
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Country | US
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Telephone | 541-500-8655
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Fax | 800-433-1396
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Provider Business Mailing Address
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Address Line | 219 VANCOUVER AVE
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 317-407-5573
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Fax | 833-414-3961
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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 | 34005730A
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License Number State | IN
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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 | L4990
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License Number State | OR
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