Provider Demographics
NPI:1487642385
Name:DUNN, RYAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:L
Last Name:DUNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2919
Mailing Address - Country:US
Mailing Address - Phone:330-343-6600
Mailing Address - Fax:330-343-6405
Practice Address - Street 1:125 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2919
Practice Address - Country:US
Practice Address - Phone:330-343-6600
Practice Address - Fax:330-343-6405
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5154103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321100Medicaid
OHDUCP19054Medicare ID - Type UnspecifiedINDIVIDUAL
OHRY9332011Medicare ID - Type UnspecifiedGROUP