MEDICARE: SHANNON LOGAN 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	104100000X	Social Worker	229852	MA

General Provider Information

NPI Number	:	1770454886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LOGAN RYAN

Provider Business Mailing Address
First Line	:	47 LEONARD ST
Second Line	:
City	:	LEEDS
State	:	MA
Zip	:	01053-9717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 ROCKY HILL RD
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-4050
Country	:	US
Telephone Number	:	413-584-5911
Fax Number	:

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

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “ SHANNON LOGAN RYAN ” Practice Location

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