Provider Demographics
NPI:1912009762
Name:RYAN, PATRICIA SUE (MSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SUE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 BUCKINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1006
Mailing Address - Country:US
Mailing Address - Phone:630-910-3106
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-460-2721
Practice Address - Fax:708-226-2621
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical