Provider Demographics
NPI:1538330865
Name:RYAN, GAIL LEE (RN MS CRC LCPC)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RN MS CRC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3777
Mailing Address - Street 2:INNOVATIVE REHABILITATION COUNSULTING PLC
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-262-3766
Mailing Address - Fax:630-262-3767
Practice Address - Street 1:3461 WINDING MEADOW LANE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-262-3766
Practice Address - Fax:630-262-3767
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00015013171M00000X
IL101Y00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor