Provider Demographics
NPI:1811946106
Name:RYAN, PATRICIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 GRAND AVE.
Mailing Address - Street 2:STE. 206
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-650-1317
Mailing Address - Fax:847-847-7657
Practice Address - Street 1:5445 GRAND AVE.
Practice Address - Street 2:STE. 206
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-650-1317
Practice Address - Fax:847-847-7657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical