Provider Demographics
NPI:1558871152
Name:WILHELM, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WILHELM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 FISHINGER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2302
Mailing Address - Country:US
Mailing Address - Phone:614-822-7819
Mailing Address - Fax:614-372-5590
Practice Address - Street 1:1080 FISHINGER RD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2302
Practice Address - Country:US
Practice Address - Phone:614-822-7819
Practice Address - Fax:614-372-5590
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health