Provider Demographics
NPI:1811229461
Name:SPOTLESON, RYAN SEAN
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SEAN
Last Name:SPOTLESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 N 73RD PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1411
Mailing Address - Country:US
Mailing Address - Phone:602-358-5895
Mailing Address - Fax:
Practice Address - Street 1:2721 N 73RD PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1411
Practice Address - Country:US
Practice Address - Phone:602-358-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA65362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant