Provider Demographics
NPI:1285116111
Name:STADNIK, RYAN DAVID
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:STADNIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 E 148TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4371
Mailing Address - Country:US
Mailing Address - Phone:317-574-1254
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:2506 WILLOWBROOK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1500
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043765A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist