Healthcare Provider Details

I. General information

NPI: 1285454470
Provider Name (Legal Business Name): MELISSA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 TOMLINSON RD STE B
WESTFIELD IN
46074-6701
US

IV. Provider business mailing address

19500 TOMLINSON RD STE B
WESTFIELD IN
46074-6701
US

V. Phone/Fax

Practice location:
  • Phone: 317-867-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1600187
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: