| Doctor Name: | RYUSHIN CREEDON |
| NPI Number: | 1144612599 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA |
| License Number: | |
| Business Practice Address: | 365 Ne Court St Prineville, OR - 977541936 |
| Business Phone Number: | 5413235330 |
| Business Fax Number: | 5414476694 |
| Mailing Address: | 365 Ne Court St, PRINEVILLE |
| State: | OR |
| Postal Code: | 977541936 |
| Phone Number: | 5413235330 |
| Fax Number: | 5414476694 |
| NPI Enumeration Date: | 02/23/2015 |
| NPI Last Update Date: | 02/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |