Provider Demographics
NPI:1417004748
Name:MCCREERY, RYAN W (MS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:W
Last Name:MCCREERY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:402-498-6540
Practice Address - Fax:402-498-6512
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE238231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8718296Medicaid
IA9718296Medicaid
IA0718296Medicaid
IA0718403Medicaid
IA1718296Medicaid
IA2718296Medicaid
NE37009OtherBCBS BT
IA3718296Medicaid
IA7718296Medicaid
IA6718296Medicaid
IA1718403Medicaid
NE37006OtherBCBS ENT
IA4718296Medicaid
IA5718296Medicaid
IA0718296Medicaid