Provider Demographics
NPI:1851904940
Name:MONDRY, RYANNE EILEEN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RYANNE
Middle Name:EILEEN
Last Name:MONDRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:RYANNE
Other - Middle Name:EILEEN
Other - Last Name:OETMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4150 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3605
Mailing Address - Country:US
Mailing Address - Phone:616-913-3084
Mailing Address - Fax:616-913-2037
Practice Address - Street 1:4150 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3605
Practice Address - Country:US
Practice Address - Phone:616-913-3084
Practice Address - Fax:616-913-2037
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010986431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical