Provider Demographics
NPI:1689834210
Name:RYAN, CAROLYN S (ACA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:S
Last Name:RYAN
Suffix:
Gender:F
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 MIDWAY RD
Mailing Address - Street 2:#403
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6813
Mailing Address - Country:US
Mailing Address - Phone:972-247-1377
Mailing Address - Fax:972-484-8851
Practice Address - Street 1:12801 MIDWAY RD
Practice Address - Street 2:#403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6813
Practice Address - Country:US
Practice Address - Phone:972-247-1377
Practice Address - Fax:972-484-8851
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50169237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist