MEDICARE: RYAN A AVERY CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	180596	OH

General Provider Information

NPI Number	:	1558008466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN A AVERY CDCA

Provider Business Mailing Address
First Line	:	479 STEPHENS RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-2139
Country	:	US
Telephone Number	:	330-993-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	479 STEPHENS RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-2139
Country	:	US
Telephone Number	:	330-993-0175
Fax Number	:

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

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	05/13/2022

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Directions to “ RYAN A AVERY CDCA” Practice Location

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