Provider Demographics
NPI:1154123982
Name:AYALA, RYAN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:AYALA
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 N HUMBOLDT BLVD APT 32
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3075
Mailing Address - Country:US
Mailing Address - Phone:323-213-7963
Mailing Address - Fax:
Practice Address - Street 1:2660 N HUMBOLDT BLVD APT 32
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3075
Practice Address - Country:US
Practice Address - Phone:323-213-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116891231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical