MEDICARE: MRS. CHEL'SEA RYAN 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	17120	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093194532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHEL'SEA RYAN LCSW

Provider Business Mailing Address
First Line	:	1110 W MONTEREY ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3562
Country	:	US
Telephone Number	:	804-305-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1808
Country	:	US
Telephone Number	:	602-595-8145
Fax Number	:

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	08/20/2024

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