Provider Demographics
NPI:1003555145
Name:RYAN, MIKAYLA LEANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:LEANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1464
Mailing Address - Country:US
Mailing Address - Phone:330-936-3091
Mailing Address - Fax:
Practice Address - Street 1:24 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1464
Practice Address - Country:US
Practice Address - Phone:330-936-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20221984-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty