Provider Demographics
NPI:1861175861
Name:FIEDLER, RYAN (MA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 E WARNER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3417
Mailing Address - Country:US
Mailing Address - Phone:602-684-4882
Mailing Address - Fax:
Practice Address - Street 1:2033 E WARNER RD # SITE111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3417
Practice Address - Country:US
Practice Address - Phone:602-684-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC13874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health