Provider Demographics
NPI:1851932503
Name:CORNOYER, RYAN MICHAEL (LSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:CORNOYER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 TALMADGE WOODS
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2100
Mailing Address - Country:US
Mailing Address - Phone:734-735-1113
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST BLDG G
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2211
Practice Address - Country:US
Practice Address - Phone:419-824-6350
Practice Address - Fax:419-882-3847
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19036341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical