Provider Demographics
NPI:1982621868
Name:RYLANDER, ELLEN A (MSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:RYLANDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:A
Other - Last Name:SWIGGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2591
Mailing Address - Fax:
Practice Address - Street 1:339 REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2020
Practice Address - Country:US
Practice Address - Phone:920-320-8600
Practice Address - Fax:920-320-8662
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S54451OtherCIGNA
WI104100000XMedicaid
29449OtherNETWORK HEALTH PLAN
WI104100000XMedicaid