Provider Demographics
NPI:1467019539
Name:RYAN, JENIFER JOICE (LCSW-BACS, C-SSWS)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:JOICE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW-BACS, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2406
Mailing Address - Country:US
Mailing Address - Phone:318-597-5180
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2406
Practice Address - Country:US
Practice Address - Phone:318-597-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical