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NPI Code Detail

MEDICARE: PAUL CARLETON RYALS LICSW

MEDICARE: PAUL CARLETON RYALS LICSW
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
11041C0700XClinical Social Worker16789MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16255168OTHERMNMEDICA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38G624DIOTHERMNBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1336152644
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL CARLETON RYALS LICSW
Provider Business Mailing Address
First Line : 6529 44TH AVENUE NORTH
Second Line : 6529 44TH AVE NORTH
City : CRYSTAL
State : MN
Zip : 55428
Country : US
Telephone Number : 763-537-1886
Fax Number :
Provider Business Practice Location Address
First Line : 7362 UNIVERSITY AVE NE
Second Line : SUITE 101
City : FRIDLEY
State : MN
Zip : 55432-3142
Country : US
Telephone Number : 763-503-3981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 05/14/2008

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Directions to “ PAUL CARLETON RYALS LICSW” Practice Location

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