Provider Demographics
NPI:1629800842
Name:RYAN, MICAILAH JOY (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MICAILAH
Middle Name:JOY
Last Name:RYAN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SPA RD APT 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-5946
Mailing Address - Country:US
Mailing Address - Phone:407-775-1341
Mailing Address - Fax:
Practice Address - Street 1:180 GREEN ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2502
Practice Address - Country:US
Practice Address - Phone:407-775-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist