Provider Demographics
NPI:1073019154
Name:RYAN, MELANIE
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:OLD WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43768-0094
Mailing Address - Country:US
Mailing Address - Phone:740-489-5571
Mailing Address - Fax:740-489-5004
Practice Address - Street 1:239 A OLD NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:OLD WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43768-0094
Practice Address - Country:US
Practice Address - Phone:740-489-5571
Practice Address - Fax:740-489-5004
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator