Provider Demographics
NPI:1437358785
Name:RYERSON, DEANNA
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:RYERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:POLLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:103 LAUREL HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:720-480-4019
Mailing Address - Fax:
Practice Address - Street 1:103 LAUREL HILL DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:720-480-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3225103TC0700X
VT048-0134129103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical