Provider Demographics
NPI:1255500385
Name:MCCLURE, RYAN EDWARD (MSW LISW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EDWARD
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E EUCLID
Mailing Address - Street 2:SUITE 151
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313
Mailing Address - Country:US
Mailing Address - Phone:515-255-8399
Mailing Address - Fax:515-255-8405
Practice Address - Street 1:100 E EUCLID
Practice Address - Street 2:SUITE 151
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313
Practice Address - Country:US
Practice Address - Phone:515-255-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469676Medicaid