Basic Information
| Provider Information | |||||||||
| NPI: | 1972674182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | JOAN | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 NEWHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117175624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318132143 | ||||||||
| FaxNumber: | 8885526176 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 DREISER LOOP | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104752704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712955 | ||||||||
| FaxNumber: | 8885831283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 016083 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.