MEDICARE: SIOBHAN RYAN-PERRY LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093016909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIOBHAN RYAN-PERRY LCSW

Provider Business Mailing Address
First Line	:	PO BOX 671205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-1205
Country	:	US
Telephone Number	:	866-890-6390
Fax Number	:	469-735-4640

Provider Business Practice Location Address
First Line	:	NUNN DRIVE
Second Line	:	UNIVERSITY CENTER #440
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41099
Country	:	US
Telephone Number	:	859-572-5650
Fax Number	:	859-572-5615

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

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	11/09/2010

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