Provider Demographics
NPI:1356620942
Name:MCKELLEY, RYAN ANDREW (PHD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:MCKELLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2066
Mailing Address - Country:US
Mailing Address - Phone:608-797-3313
Mailing Address - Fax:
Practice Address - Street 1:542 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2066
Practice Address - Country:US
Practice Address - Phone:608-797-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2924-57103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling