Provider Demographics
NPI:1215485990
Name:GOETTSCH, RYAN JAMES (LISW-S)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:GOETTSCH
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD STE M
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4380
Mailing Address - Country:US
Mailing Address - Phone:330-402-9341
Mailing Address - Fax:
Practice Address - Street 1:725 BOARDMAN CANFIELD RD STE M
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4380
Practice Address - Country:US
Practice Address - Phone:330-330-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1610121-TRNE104100000X
OHI.20024351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker