Provider Demographics
NPI:1861575987
Name:RYAN, JAMES JOSEPH (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:RYAN
Suffix:
Gender:M
Credentials:MSW LCSW
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Mailing Address - Street 1:6072 BRYNWOOD DRIVE
Mailing Address - Street 2:JAMES L RYAN MSW LCSW SUITE 105
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114
Mailing Address - Country:US
Mailing Address - Phone:815-398-7483
Mailing Address - Fax:815-798-2116
Practice Address - Street 1:6072 BRYNWOOD DRIVE
Practice Address - Street 2:JAMES L RYAN MSW LCSW SUITE 105
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114
Practice Address - Country:US
Practice Address - Phone:815-398-7483
Practice Address - Fax:815-798-2116
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1490007391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL978500Medicare ID - Type Unspecified