Healthcare Provider Details

I. General information

NPI: 1558526921
Provider Name (Legal Business Name): LISA M RYCKBOST MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 EASTWIND DR
WESTERVILLE OH
43081-3329
US

IV. Provider business mailing address

936 EASTWIND DR
WESTERVILLE OH
43081-3329
US

V. Phone/Fax

Practice location:
  • Phone: 146-634-6005
  • Fax:
Mailing address:
  • Phone: 146-634-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-8849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: