Provider Demographics
NPI:1033692306
Name:CAREY, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CAREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 WINDSOR RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4276
Mailing Address - Country:US
Mailing Address - Phone:159-861-1138
Mailing Address - Fax:815-986-1119
Practice Address - Street 1:1752 WINDSOR RD STE 203
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4276
Practice Address - Country:US
Practice Address - Phone:815-986-1113
Practice Address - Fax:815-986-1119
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker