Provider Demographics
NPI:1629693478
Name:KALAKEWICH, RYAN D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:KALAKEWICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MINSINGER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-2233
Mailing Address - Country:US
Mailing Address - Phone:724-331-4733
Mailing Address - Fax:
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:303-234-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical