MEDICARE: RYAN MONUAI VINING-CALDWELL

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
1	101YP2500X	Professional Counselor	180016267	IL

General Provider Information

NPI Number	:	1528937240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MONUAI VINING-CALDWELL

Provider Business Mailing Address
First Line	:	6516 N UNIVERSITY ST APT 1122
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-2752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 N UNIVERSITY ST APT 1122
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-2752
Country	:	US
Telephone Number	:	773-984-4207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	01/22/2026

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