Provider Demographics
NPI:1962875849
Name:RYAN, LINDA ANN (LADC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:8 LAKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1518
Mailing Address - Country:US
Mailing Address - Phone:802-373-6505
Mailing Address - Fax:
Practice Address - Street 1:476 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1300
Practice Address - Country:US
Practice Address - Phone:802-373-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)