Provider Demographics
NPI:1225783269
Name:RYAN, TERAH MARGARET (MSW, LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:MARGARET
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ELMWOOD ST NE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6223
Mailing Address - Country:US
Mailing Address - Phone:616-212-9998
Mailing Address - Fax:
Practice Address - Street 1:2001 L ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4955
Practice Address - Country:US
Practice Address - Phone:202-599-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011169041041C0700X
MD308871041C0700X
DCLC2000025721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801116904OtherLICENSED MASTERS SOCIAL WORKER- CLINICAL
DCLC200002572OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER
MD30887OtherLICENSED CERTIFIED SOCIAL WORKER- CLINICAL