Provider Demographics
NPI:1801772843
Name:O'HERN, RYAN (LPC-IT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:O'HERN
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GATEWAY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1450
Mailing Address - Country:US
Mailing Address - Phone:608-377-3864
Mailing Address - Fax:608-716-3155
Practice Address - Street 1:522 GATEWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1450
Practice Address - Country:US
Practice Address - Phone:608-377-3864
Practice Address - Fax:608-716-3155
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional