Provider Demographics
NPI:1043678394
Name:RYAN, ELIZABETH BARRETT (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BARRETT
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2313
Mailing Address - Country:US
Mailing Address - Phone:917-817-0836
Mailing Address - Fax:718-657-1208
Practice Address - Street 1:8516 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2313
Practice Address - Country:US
Practice Address - Phone:917-817-0836
Practice Address - Fax:718-657-1208
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist