Provider Demographics
NPI:1639385701
Name:RYAN, SUSAN W (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:RYAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RITTENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2547
Mailing Address - Country:US
Mailing Address - Phone:215-513-1995
Mailing Address - Fax:215-513-9769
Practice Address - Street 1:51 RITTENHOUSE RD
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2547
Practice Address - Country:US
Practice Address - Phone:215-513-1995
Practice Address - Fax:215-513-9769
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001923L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist