Provider Demographics
NPI:1699716969
Name:RYAN, KATHLEEN (PH D)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2195
Mailing Address - Country:US
Mailing Address - Phone:614-895-1555
Mailing Address - Fax:844-441-8763
Practice Address - Street 1:3 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2195
Practice Address - Country:US
Practice Address - Phone:614-895-1555
Practice Address - Fax:844-441-8763
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRYCP14342Medicare ID - Type Unspecified