MEDICARE: JANELLE RYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14046508	NE

General Provider Information

NPI Number	:	1184176935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE RYAN

Provider Business Mailing Address
First Line	:	2508 27TH STREET PO BX 947
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68602-0947
Country	:	US
Telephone Number	:	402-563-7000
Fax Number	:	402-563-7025

Provider Business Practice Location Address
First Line	:	2410 16TH STREET
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601
Country	:	US
Telephone Number	:	402-563-7000
Fax Number	:	402-563-7025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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Directions to “ JANELLE RYAN ” Practice Location

Language	Start Address	Practice Location

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