Provider Demographics
NPI:1306339288
Name:EISERT, RYAN THOMAS (LSW, CDCA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:EISERT
Suffix:
Gender:M
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1315
Mailing Address - Country:US
Mailing Address - Phone:614-291-4691
Mailing Address - Fax:
Practice Address - Street 1:825 DENNISON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1315
Practice Address - Country:US
Practice Address - Phone:614-291-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2022-12-06
Deactivation Date:2022-11-29
Deactivation Code:
Reactivation Date:2022-12-06
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167018101YA0400X
OHS.2208553104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)