Healthcare Provider Details

I. General information

NPI: 1447169958
Provider Name (Legal Business Name): BECCA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 MOULIN AVE NE
ALLIANCE OH
44601-5906
US

IV. Provider business mailing address

10140 SOUTHWYCK AVE NW
NORTH CANTON OH
44720-8271
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-7453
  • Fax:
Mailing address:
  • Phone: 330-823-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: