Provider Demographics
NPI:1497068092
Name:RYAN, WENDY A (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:RYAN, LCSW, LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 E HORIZON DR
Mailing Address - Street 2:STE D
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8035
Mailing Address - Country:US
Mailing Address - Phone:702-293-2696
Mailing Address - Fax:702-475-8220
Practice Address - Street 1:220 E HORIZON DR
Practice Address - Street 2:SUITE D
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8035
Practice Address - Country:US
Practice Address - Phone:702-293-2696
Practice Address - Fax:702-475-8220
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6329-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497068092Medicaid