Provider Demographics
NPI:1508597618
Name:RYAN, EDEN
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:RYAN
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 1:700 SE CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1561
Mailing Address - Country:US
Mailing Address - Phone:217-773-3325
Mailing Address - Fax:217-773-2425
Practice Address - Street 1:120 N WILLIAMS INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1300
Practice Address - Country:US
Practice Address - Phone:217-285-4436
Practice Address - Fax:217-285-2804
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)