Ryan Michael Kordiak, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305622 Issued in MN

Practice address

7701 York Ave S Ste 350
Edina, MN 55435

Phone

(952) 926-2526

Fax

(952) 926-6791

NPI assigned

Oct 28, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Club Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Edina, MN
  • NPI 1023032703
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1376915439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7701 YORK AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-926-2526",
            "fax_number": "952-926-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 YORK AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-926-2526",
            "fax_number": "952-926-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDIAK",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-28",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305622",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marynne L Kopischke, N.P.
• Kimberly Kopitzke, RN, CNP
• Alan J Kopp, M.D.
• Nathan William Koranda, DNP
• Melissa Lynn Korb, M.D.
• Alexander Vadimovich Kornel, LAC
• George Matthen Koshy, M.D.
• Robin Koska, CES, OTR/L
• Abigail Rose Koski, DO
• Larry William Kotek, M.D.

• Addiction (Substance Use Disorder) Counselor in Edina, MN
• Providers in Edina, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.