Provider Demographics
NPI:1558612499
Name:RYAN, MAUREEN F
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:F
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 1:1230 JOHNSON FERRY PL
Mailing Address - Street 2:SUITE G-10
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2048
Mailing Address - Country:US
Mailing Address - Phone:404-321-6705
Mailing Address - Fax:404-551-3891
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:SUITE G-10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:404-321-6705
Practice Address - Fax:404-551-3891
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist