Provider Demographics
NPI:1386663888
Name:RYAN, PATRICK DENNIS (LISW)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DENNIS
Last Name:RYAN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:DENNIS
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:2041 SLABTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3307
Mailing Address - Country:US
Mailing Address - Phone:419-225-7157
Mailing Address - Fax:419-225-5850
Practice Address - Street 1:2041 SLABTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3307
Practice Address - Country:US
Practice Address - Phone:419-225-7157
Practice Address - Fax:419-225-5850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00039661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical