Provider Demographics
NPI:1508518135
Name:HENRICK, RYAN JOHN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:HENRICK
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:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0516
Mailing Address - Country:US
Mailing Address - Phone:541-362-6023
Mailing Address - Fax:541-316-7422
Practice Address - Street 1:908 NE 4TH ST # 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4646
Practice Address - Country:US
Practice Address - Phone:541-617-7365
Practice Address - Fax:541-316-7422
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health