MEDICARE: AMY RYAN THERAPY LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1376491266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY RYAN THERAPY LLC

Provider Business Mailing Address
First Line	:	5164 W MONTROSE AVE APT 1C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1479
Country	:	US
Telephone Number	:	906-420-0063
Fax Number	:

Provider Business Practice Location Address
First Line	:	5164 W MONTROSE AVE APT 1C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1479
Country	:	US
Telephone Number	:	906-420-0063
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. AMY RYAN
Credential	:	LCPC, LMFT
Telephone Number	:	906-420-0063

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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