Provider Demographics
NPI:1902519085
Name:BIRCH, RYAN L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:L
Other - Last Name:BELLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5420
Mailing Address - Country:US
Mailing Address - Phone:518-852-4436
Mailing Address - Fax:
Practice Address - Street 1:2 PERSHING DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5420
Practice Address - Country:US
Practice Address - Phone:518-852-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty