Healthcare Provider Details

I. General information

NPI: 1417528779
Provider Name (Legal Business Name): RYAN JAMES YATES MS, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 LATHAM DR
MADISON WI
53713-4613
US

IV. Provider business mailing address

3101 LATHAM DR
MADISON WI
53713-4613
US

V. Phone/Fax

Practice location:
  • Phone: 608-286-1132
  • Fax:
Mailing address:
  • Phone: 608-286-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00277523
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: