Ryan, Jerry David

Ryan, Jerry David is an sole proprietor health care provider with primary practice located at 19142 Molalla Ave., Suite A, , Oregon City OR 97045-7166. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Ryan, Jerry David can be contacted via phone (503) 348-6177.

Contact Information

Primary practice address
19142 Molalla Ave., Suite A, Oregon City OR 97045-7166
Phone: (503) 348-6177
Fax: (593) 632-5497
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X R2757 Oregon
Behavioral Health & Social Service Providers / Professional 101YP2500X Oregon

Profile Details

NPI number 1245667385
LBN Legal business name Ryan, Jerry David
Credentials LPC.CRC.NCC,MS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 3rd, 2013
Last updated Nov 10th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245667385 NPPES
Oregon MEDICAID 5006884107

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