MEDICARE: JESSICA RYAN

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	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1487517009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RYAN

Provider Business Mailing Address
First Line	:	450 NE EMERSON AVE APT 1
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20550 MURPHY RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3002
Country	:	US
Telephone Number	:	541-355-2100
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ JESSICA RYAN ” Practice Location

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