Provider Demographics
NPI:1740177252
Name:RYAN, ANASTASIA-EKATERINA
Entity type:Individual
Prefix:
First Name:ANASTASIA-EKATERINA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14725 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-9289
Mailing Address - Country:US
Mailing Address - Phone:316-209-1247
Mailing Address - Fax:
Practice Address - Street 1:9393 W 110TH ST # 51
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1442
Practice Address - Country:US
Practice Address - Phone:316-209-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician