Provider Demographics
NPI:1588130488
Name:RYANS, HERMAN LEE (CDP)
Entity type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:LEE
Last Name:RYANS
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 S LEFEVRE ST
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-9533
Mailing Address - Country:US
Mailing Address - Phone:509-218-9870
Mailing Address - Fax:
Practice Address - Street 1:1311 S LEFEVRE ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9533
Practice Address - Country:US
Practice Address - Phone:509-218-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)