Healthcare Provider Details

I. General information

NPI: 1881911279
Provider Name (Legal Business Name): KAARIN ANDERSON RYAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WASHINGTON AVE STE 368
GRAND HAVEN MI
49417-1378
US

IV. Provider business mailing address

410 FORT SALONGA RD
NORTHPORT NY
11768-3046
US

V. Phone/Fax

Practice location:
  • Phone: 616-843-1196
  • Fax: 631-261-6052
Mailing address:
  • Phone: 631-262-8561
  • Fax: 631-261-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301014390
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301014390
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014390
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11518751
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number02419201
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11518751
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number02419201
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number02419201
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301014390
License Number StateMI
# 10
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number02419201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: