Individual
MRS. MARY T. RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., R.D.
Contact information
Practice address
535 CACHE CREEK DR, JACKSON, WY 83001-8653
(307) 690-5785
Mailing address
PO BOX 1076, JACKSON, WY 83001-1076
(073) 690-5785
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
800
WY
133V00000X
Registered Dietitian
886773
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116673500
—
WY
Enumeration date
05/23/2007
Last updated
03/06/2019
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