Provider Demographics
NPI:1891242467
Name:HOESTEN, RYAN EVAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:EVAN
Last Name:HOESTEN
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4206
Mailing Address - Country:US
Mailing Address - Phone:954-821-8684
Mailing Address - Fax:
Practice Address - Street 1:644 FERGUSON DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1023
Practice Address - Country:US
Practice Address - Phone:866-311-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7715235Z00000X
FLSA15983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA15983OtherFLORIDA SPEECH-LANGUAGE PATHOLOGY LICENSURE
CASP30125OtherCALIFORNIA SPEECH-LANGUAGE PATHOLOGY LICENSURE
FL018701300Medicaid
VA2202009512OtherVIRGINIA SPEECH-LANGUAGE PATHOLOGY LICENSURE