Individual
MR. JERRY DAVID RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC.CRC.NCC,MS
Contact information
Practice address
19142 MOLALLA AVE., SUITE A,, OREGON CITY, OR 97045-7166
(503) 348-6177
(593) 632-5497
Mailing address
PO BOX 548, 19142 MOLALLA AVE, SUITE A, OREGON CITY, OR 97045-7166
(503) 348-6177
(503) 632-5497
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
R2757
OR
101YP2500X
Professional Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5006884107
—
OR
Enumeration date
10/03/2013
Last updated
11/10/2016
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