Healthcare Provider Details

I. General information

NPI: 1538330865
Provider Name (Legal Business Name): GAIL LEE RYAN RN MS CRC LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 WINDING MEADOW LANE
GENEVA IL
60134
US

IV. Provider business mailing address

PO BOX 3777 INNOVATIVE REHABILITATION COUNSULTING PLC
ST CHARLES IL
60174
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-3766
  • Fax: 630-262-3767
Mailing address:
  • Phone: 630-262-3766
  • Fax: 630-262-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00015013
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: