Provider Demographics
NPI:1083817555
Name:RYAN, HEATHER R (PCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:RYAN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JAVIT CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2409
Mailing Address - Country:US
Mailing Address - Phone:330-793-2487
Mailing Address - Fax:330-793-4559
Practice Address - Street 1:142 JAVIT CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2409
Practice Address - Country:US
Practice Address - Phone:330-793-2487
Practice Address - Fax:330-793-4559
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health