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NPI Code Detail

MEDICARE: RYAN JAMES KELLY

MEDICARE: RYAN JAMES KELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social Worker
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1013590272
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN JAMES KELLY
Provider Business Mailing Address
First Line : 702 SUNSET DR
Second Line :
City : ONTARIO
State : OR
Zip : 97914-3121
Country : US
Telephone Number : 541-889-9176
Fax Number : 541-889-7873
Provider Business Practice Location Address
First Line : 702 SUNSET DR
Second Line :
City : ONTARIO
State : OR
Zip : 97914-3121
Country : US
Telephone Number : 541-889-9176
Fax Number : 541-889-7873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2021
Last Update Date : 03/04/2026

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