Provider Demographics
NPI:1720232747
Name:RYAN, MICHELE LYNN (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:MOORE-RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:43 STAFFORDS'S CROSSING
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159
Mailing Address - Country:US
Mailing Address - Phone:518-229-5058
Mailing Address - Fax:
Practice Address - Street 1:43 STAFFORDS'S XING
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159
Practice Address - Country:US
Practice Address - Phone:518-229-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008078172V00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No172V00000XOther Service ProvidersCommunity Health Worker