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NPI Code Detail

MEDICARE: RYAN VAN VOORHIS

MEDICARE:   RYAN  VAN VOORHIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.012554IL

General Provider Information

NPI Number : 1417399221
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN VAN VOORHIS
Provider Business Mailing Address
First Line : 2346 W AUGUSTA BLVD
Second Line : 1F
City : CHICAGO
State : IL
Zip : 60622-4886
Country : US
Telephone Number : 773-297-9359
Fax Number :
Provider Business Practice Location Address
First Line : 2346 W AUGUSTA BLVD
Second Line : 1F
City : CHICAGO
State : IL
Zip : 60622-4886
Country : US
Telephone Number : 773-297-9359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2013
Last Update Date : 07/22/2013

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Directions to “ RYAN VAN VOORHIS ” Practice Location

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