Healthcare Provider Details

I. General information

NPI: 1740680883
Provider Name (Legal Business Name): RYAN A DUCKWORTH PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CENTURY LN STE 2
HOLLAND MI
49423-4318
US

IV. Provider business mailing address

503 CENTURY LN STE 2
HOLLAND MI
49423-4318
US

V. Phone/Fax

Practice location:
  • Phone: 616-795-0298
  • Fax: 616-834-0446
Mailing address:
  • Phone: 616-795-0298
  • Fax: 616-834-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016570
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: