DR. RYAN A WISNIEWSKI (PH.D.) – Mental Health Counselor, NPI 1104389428

DR. RYAN A WISNIEWSKI (PH.D.) is a healthcare provider. based in Elyria, Ohio. specializing in MENTAL HEALTH COUNSELOR. They hold the professional credentials PH.D.. They hold a License No. E.2505686 (OH). The NPI Number for DR. RYAN A WISNIEWSKI (PH.D.) is 1104389428

Main info

Male
Sole Proprietor
6 Years Of Experience
Name
DR. RYAN A WISNIEWSKI (PH.D.)
NPI
1104389428
Phone
(440) 323-5707
Address
312 3RD ST
Enumeration Date
12 April 2019
Last Update Date
17 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4193188533
Graduation Year
2020 (6 years ago)
PAC ID
2860995735
Group Practice PAC ID
1254736853
Professional Enrollment ID
I20250915003179
Address ID
OH436061356TO3454XCTXX404
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience43
Completeness85
Years active:7State licenses:1Digital endpointsOther names

2,538 MENTAL HEALTH COUNSELOR in OH

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Provider Addresses for DR. RYAN A WISNIEWSKI (PH.D.)

  • 312, 3rd Street, Elyria, Lorain County, Ohio, 44035, United States

    ELYRIA, OH 440355618

    Phone: (440) 323-5707

    Type: Location

  • Portside Drive, Vermilion Township, Erie County, Ohio, 44089, United States

    VERMILION, OH 440899148

    Phone: (440) 225-0825

    Type: Mailing

  • 3454 OAK ALLEY CT STE 504

    TOLEDO, OH 436061356

    Phone: (419) 318-8533

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250915003179IMental Health CounselorOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44035)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254736853View full group profile
NameSpecialtyState
Clinical PsychologistOH
Clinical Social WorkerOH
Mental Health CounselorOH
Mental Health CounselorOH
Mental Health CounselorOH
Clinical Social WorkerOH
Clinical Social WorkerOH
Mental Health CounselorOH

Reviews

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Frequently asked questions

What federal number belongs to DR. RYAN A WISNIEWSKI (PH.D.)?
The federal identifier for DR. RYAN A WISNIEWSKI (PH.D.) is NPI 1104389428.
Is DR. RYAN A WISNIEWSKI (PH.D.)'s NPI currently valid?
The extract we use shows DR. RYAN A WISNIEWSKI (PH.D.) as active.
Does DR. RYAN A WISNIEWSKI (PH.D.) list a primary specialty?
If you are matching referrals, note Mental Health Counselor for DR. RYAN A WISNIEWSKI (PH.D.). Clinical services aligned with this taxonomy classification.
What location shows for DR. RYAN A WISNIEWSKI (PH.D.)?
We surface Elyria, Ohio for DR. RYAN A WISNIEWSKI (PH.D.) based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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