Provider Demographics
NPI:1821180415
Name:RYAN, PATRICIA EILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:EILEEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
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 815
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0815
Mailing Address - Country:US
Mailing Address - Phone:406-862-2208
Mailing Address - Fax:
Practice Address - Street 1:120 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8419
Practice Address - Country:US
Practice Address - Phone:406-212-7016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCSW-344101YM0800X
MTLMT 627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070851OtherBLUE CROSS/ BLUE SHIELD
MT0000502749Medicaid