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General NPI Number Information
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NPI Number | 1477836864
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Entity Type | Individual
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Provider Name | CATHY E. RYAN M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 1035 W GLEN OAKS LN SUITE 110
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City | MEQUON
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State | WI
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Zip | 53092-3392
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Country | US
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Telephone | 262-240-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 4655 N MURRAY AVE
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City | WHITEFISH BAY
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State | WI
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Zip | 53211-1259
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 953-124
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License Number State | WI
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