Kirsten Elise Ryan, DT, LCPC

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

KR42150502P Issued in IL

Practice address

215 S Springside Dr
Round Lake Beach, IL 60073-8139

Phone

(847) 477-9816

Fax

(847) 740-1749

NPI assigned

Jan 15, 2007

Last updated

Nov 11, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fundamentals Pediatric Therapy and Consulting Inc.

  • Early Intervention Provider Agency
  • Round Lake Beach, IL
  • NPI 1922473008
  NPD (past) Authorized official

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289433600000",
    "number": "1942351184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 S SPRINGSIDE DR",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600738139",
            "telephone_number": "847-477-9816",
            "fax_number": "847-740-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 S SPRINGSIDE DR",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600738139",
            "telephone_number": "847-477-9816",
            "fax_number": "847-740-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KIRSTEN",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "DT, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2010-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "KR42150502P",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.007497",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rollins Dental Center
• Round Lake Medical Imaging Inc
• Round Lake Medical Suites
• Round Lake MRI, Inc
• Steven L Ruohomaki, L.C.S.W.
• Safeway Inc (Dominicks)
• Yareli Sanchez Olmos
• Barbara Sargent, PNP
• Katherine M Schneider, PT DPT ATC
• Wendi A Sears

• Developmental Therapist in Round Lake Beach, IL
• Providers in Round Lake Beach, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; 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.