MEDICARE: RYAN VAN VOORHIS

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	1041C0700X	Clinical Social Worker	149.012554	IL

General Provider Information

NPI Number	:	1417399221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN VAN VOORHIS

Provider Business Mailing Address
First Line	:	2346 W AUGUSTA BLVD
Second Line	:	1F
City	:	CHICAGO
State	:	IL
Zip	:	60622-4886
Country	:	US
Telephone Number	:	773-297-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 W AUGUSTA BLVD
Second Line	:	1F
City	:	CHICAGO
State	:	IL
Zip	:	60622-4886
Country	:	US
Telephone Number	:	773-297-9359
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “ RYAN VAN VOORHIS ” Practice Location

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