MEDICARE: KRISTEN RYDER SSP, LLMSW-C

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
1	103TS0200X	School Psychologist	SP0000000792258	MI
2	1041C0700X	Clinical Social Worker	6851117943	MI

General Provider Information

NPI Number	:	1073119632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN RYDER SSP, LLMSW-C

Provider Business Mailing Address
First Line	:	2632 CROSSING CIR # 1012
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7930
Country	:	US
Telephone Number	:	231-268-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 W GRANDVIEW PKWY STE 403
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2298
Country	:	US
Telephone Number	:	231-929-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	01/22/2026

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