Provider Demographics
NPI:1003315771
Name:RYAN, JEANNE NORGREN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:NORGREN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 INMAN PL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6853
Mailing Address - Country:US
Mailing Address - Phone:770-367-3848
Mailing Address - Fax:
Practice Address - Street 1:114 SLOAN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4922
Practice Address - Country:US
Practice Address - Phone:770-594-3065
Practice Address - Fax:770-594-3099
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20811041C0700X
GACSW0041531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical