Provider Demographics
NPI:1871072603
Name:RYAN, ASHLEY LAUREN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAUREN
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:TORNGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:1912 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4622
Mailing Address - Country:US
Mailing Address - Phone:708-668-3287
Mailing Address - Fax:
Practice Address - Street 1:1912 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4622
Practice Address - Country:US
Practice Address - Phone:708-668-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-18-31202103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst