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NPI Code Detail

MEDICARE: MR. RYAN WOMACK

MEDICARE: MR. RYAN WOMACK
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
11041C0700XClinical Social Worker149.028701IL
21041C0700XClinical Social WorkerI.2304483OH
3101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162437OH

General Provider Information

NPI Number : 1669030318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN WOMACK
Provider Business Mailing Address
First Line : 1542 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1344
Country : US
Telephone Number : 614-987-5620
Fax Number :
Provider Business Practice Location Address
First Line : 1542 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1344
Country : US
Telephone Number : 773-465-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2019
Last Update Date : 04/21/2026

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