Healthcare Provider Details

I. General information

NPI: 1447928916
Provider Name (Legal Business Name): KAYLA L RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MAIN ST STE 301
LA CROSSE WI
54601-4099
US

IV. Provider business mailing address

444 MAIN ST STE 301
LA CROSSE WI
54601-4099
US

V. Phone/Fax

Practice location:
  • Phone: 608-434-0163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130232-121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130232-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: