Provider Demographics
NPI:1679346076
Name:RYAN, CONNOR KAYLEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CONNOR
Middle Name:KAYLEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 DIANE CRES
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9K 1G2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:174 DIANE CRES
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9K 1G2
Practice Address - Country:CA
Practice Address - Phone:817-907-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011172481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical