Provider Demographics
NPI:1518069103
Name:RYAN, ELIZABETH BOYER (MSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BOYER
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 ASSISI HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3837
Mailing Address - Country:US
Mailing Address - Phone:719-955-7020
Mailing Address - Fax:719-598-0346
Practice Address - Street 1:7665 ASSISI HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3837
Practice Address - Country:US
Practice Address - Phone:719-955-7020
Practice Address - Fax:719-598-0346
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9911721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO056339Medicaid
COA5426Medicare PIN