Provider Demographics
NPI:1598236937
Name:WILSON, RYAN PATRICK (LSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:WILSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9321
Mailing Address - Country:US
Mailing Address - Phone:304-623-5661
Mailing Address - Fax:
Practice Address - Street 1:37 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7057
Practice Address - Country:US
Practice Address - Phone:304-269-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00943718104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker