| Doctor Name: | ELIZABETH RYAN |
| NPI Number: | 1063895993 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 304205 |
| Business Practice Address: | 16201 90th Street Nw, Suite 200 Otsego, MN - 553306673 |
| Business Phone Number: | 7637469492 |
| Business Fax Number: | 7637463685 |
| Mailing Address: | 1900 Silver Lake Rd Nw, Suite 110 NEW BRIGHTON |
| State: | MN |
| Postal Code: | 551121786 |
| Phone Number: | 6513791718 |
| Fax Number: | 6513791738 |
| NPI Enumeration Date: | 07/09/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 304205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |