Provider Demographics
NPI:1396418042
Name:GREENLEE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AZA
Other - Middle Name:
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1542 N MILWAUKEE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1542 N MILWAUKEE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2008
Practice Address - Country:US
Practice Address - Phone:773-504-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health