MEDICARE: SEAN MICHAEL RYAN LPC

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	3967-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437325610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MICHAEL RYAN LPC

Provider Business Mailing Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-231-4846
Fax Number	:	414-453-2538

Provider Business Practice Location Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1549
Country	:	US
Telephone Number	:	414-231-4846
Fax Number	:	414-453-2538

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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Directions to “ SEAN MICHAEL RYAN LPC” Practice Location

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