Provider Demographics
NPI:1972674182
Name:RYAN, JOAN (SLP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NEWHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5624
Mailing Address - Country:US
Mailing Address - Phone:631-813-2143
Mailing Address - Fax:888-552-6176
Practice Address - Street 1:145 DREISER LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2704
Practice Address - Country:US
Practice Address - Phone:718-671-2955
Practice Address - Fax:888-583-1283
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist