Provider Demographics
NPI:1043008949
Name:ELDREDGE, RYAN CLARK
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CLARK
Last Name:ELDREDGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14308 S WAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8179
Mailing Address - Country:US
Mailing Address - Phone:385-248-2747
Mailing Address - Fax:
Practice Address - Street 1:2655 S LAKE ERIE DR STE B
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-7351
Practice Address - Country:US
Practice Address - Phone:385-248-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator