Provider Demographics
NPI:1528260023
Name:RYAN, KATHLEEN A (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:RYAN
Other - Last Name:FUHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3124 MEDFORD CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7271
Mailing Address - Country:US
Mailing Address - Phone:630-978-0337
Mailing Address - Fax:
Practice Address - Street 1:40 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4912
Practice Address - Country:US
Practice Address - Phone:630-527-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0034851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376560OtherMEDICARE