Provider Demographics
NPI:1396177853
Name:DONG, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9855 S PRIEST DR
Mailing Address - Street 2:STE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3605
Mailing Address - Country:US
Mailing Address - Phone:480-343-4746
Mailing Address - Fax:
Practice Address - Street 1:9855 S PRIEST DR
Practice Address - Street 2:STE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3605
Practice Address - Country:US
Practice Address - Phone:480-343-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-140281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical