Individual
LESLIE RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, QMHA
Contact information
Practice address
377 LACLAIR ST, COOS BAY, OR 97420-4709
(541) 756-2057
Mailing address
92118 CAPE ARAGO HWY, COOS BAY, OR 97420-8743
(509) 679-1817
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/16/2020
Last updated
04/16/2020
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