Provider Demographics
NPI:1497808430
Name:RYAN, BERNICE MARTHA (M A CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BERNICE
Middle Name:MARTHA
Last Name:RYAN
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:BERNICE
Other - Middle Name:MARTHA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1099 KINGSTON RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:PICKERING
Mailing Address - State:ON
Mailing Address - Zip Code:L1V6V4
Mailing Address - Country:CA
Mailing Address - Phone:905-492-3626
Mailing Address - Fax:905-492-3627
Practice Address - Street 1:1099 KINGSTON RD
Practice Address - Street 2:SUITE 232
Practice Address - City:PICKERING
Practice Address - State:ON
Practice Address - Zip Code:L1V6V4
Practice Address - Country:CA
Practice Address - Phone:905-492-3626
Practice Address - Fax:905-492-3627
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012319-1235Z00000X
CASP 23674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist