Provider Demographics
NPI:1174947576
Name:PETERS, RYAN I
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:PETERS
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:1480 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 CENTER ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-9125
Practice Address - Country:US
Practice Address - Phone:419-636-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist