Basic Information
| Provider Information | |||||||||
| NPI: | 1679926158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYDER | ||||||||
| FirstName: | JESSIE | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5399 LAUBY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447201554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304977726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7565 GRANGER RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441254818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164479600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1600527 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.