Healthcare Provider Details

I. General information

NPI: 1992647770
Provider Name (Legal Business Name): RYAN T WOODARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 MARK AVE
ELGIN IL
60123-2907
US

IV. Provider business mailing address

2430 EMILY LN
ELGIN IL
60124-8743
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax:
Mailing address:
  • Phone: 847-890-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: