Provider Demographics
NPI:1467579235
Name:RYMAN, VICKI SUE (CAARR)
Entity Type:Individual
Prefix:MISS
First Name:VICKI
Middle Name:SUE
Last Name:RYMAN
Suffix:
Gender:F
Credentials:CAARR
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:SUE
Other - Last Name:RYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAARR
Mailing Address - Street 1:201 COLLEGE AVE
Mailing Address - Street 2:201 COLLEGE AV.
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5912
Mailing Address - Country:US
Mailing Address - Phone:209-524-9110
Mailing Address - Fax:209-541-2114
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:1904 RICHLAND AV.
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-541-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)