Provider Demographics
NPI:1497384515
Name:LINTHICUM, RYANN N (PPC)
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:N
Last Name:LINTHICUM
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11390
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-1390
Mailing Address - Country:US
Mailing Address - Phone:307-733-3908
Mailing Address - Fax:307-734-0017
Practice Address - Street 1:610 W BROADWAY AVE STE L1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8213
Practice Address - Country:US
Practice Address - Phone:307-733-3908
Practice Address - Fax:307-734-0017
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical