| Doctor Name: | MS. JOAN M RYAN |
| NPI Number: | 1033574629 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MACC, LCPC |
| License Number: | 180.010005 |
| Business Practice Address: | 610 N Route 31, Suite E Crystal Lake, IL - 60012 |
| Business Phone Number: | 8154448469 |
| Business Fax Number: | 8154791709 |
| Mailing Address: | 610 N Route 31, Suite E, CRYSTAL LAKE |
| State: | IL |
| Postal Code: | 60012 |
| Phone Number: | 8154448469 |
| Fax Number: | 8154791709 |
| NPI Enumeration Date: | 12/23/2015 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.010005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |