Provider Demographics
NPI:1437325610
Name:RYAN, SEAN MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S 76TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1549
Mailing Address - Country:US
Mailing Address - Phone:414-231-4846
Mailing Address - Fax:414-453-2538
Practice Address - Street 1:620 S 76TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1549
Practice Address - Country:US
Practice Address - Phone:414-231-4846
Practice Address - Fax:414-453-2538
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3967-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40928000Medicaid