Provider Demographics
NPI:1942495395
Name:RYAN, CHERIE ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:959 SOUTH CHIEF AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0001
Mailing Address - Country:US
Mailing Address - Phone:928-338-2024
Mailing Address - Fax:928-338-6037
Practice Address - Street 1:2005 FORT APACHE ROAD
Practice Address - Street 2:
Practice Address - City:FORT APACHE
Practice Address - State:AZ
Practice Address - Zip Code:85926-0001
Practice Address - Country:US
Practice Address - Phone:928-338-1353
Practice Address - Fax:928-338-6037
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL0824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ557829Medicaid