Provider Demographics
NPI:1538681317
Name:EMRY, RYAN MATTHEW
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:EMRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7019 PALMA LN
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1225
Mailing Address - Country:US
Mailing Address - Phone:847-826-3199
Mailing Address - Fax:
Practice Address - Street 1:7019 PALMA LN
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1225
Practice Address - Country:US
Practice Address - Phone:847-826-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27710103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst