Provider Demographics
NPI:1497403638
Name:WAHL, RYLIE
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 US HIGHWAY 42 SE
Mailing Address - Street 2:STE C
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9548
Mailing Address - Country:US
Mailing Address - Phone:614-879-8067
Mailing Address - Fax:614-503-0899
Practice Address - Street 1:1375 US HIGHWAY 42 SE
Practice Address - Street 2:STE C
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9548
Practice Address - Country:US
Practice Address - Phone:614-879-8067
Practice Address - Fax:614-503-0899
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305328101Y00000X
OHC.2203901-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor