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NPI Code Detail

MEDICARE: JORDAN MARIE RYAN LMSW

MEDICARE:   JORDAN MARIE RYAN  LMSW
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
1390200000XStudent in an Organized Health Care Education/Training Program
2104100000XSocial Worker7163OK

General Provider Information

NPI Number : 1629454855
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MARIE RYAN LMSW
Provider Business Mailing Address
First Line : 19320 E ADMIRAL PL STE B
Second Line :
City : CATOOSA
State : OK
Zip : 74015-3240
Country : US
Telephone Number : 918-340-5503
Fax Number : 918-340-5505
Provider Business Practice Location Address
First Line : 7477 E 46TH PL
Second Line :
City : TULSA
State : OK
Zip : 74145-6305
Country : US
Telephone Number : 918-384-0002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 07/13/2021

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Directions to “ JORDAN MARIE RYAN LMSW” Practice Location

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