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Individual

SALLY RYAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D

Contact information

Practice address
983 SPAULDING AVE SE, ADA, MI 49301-3701
(616) 956-7878
Mailing address
983 SPAULDING AVE SE, ADA, MI 49301-3701
(616) 956-7878

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
005532
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
620D1-4555
BLUE CROSS
MI
Enumeration date
03/05/2008
Last updated
03/05/2008
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