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NPI Code Detail

MEDICARE: KATHLEEN RYAN BCBA

MEDICARE: KATHLEEN RYAN BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-17-27560CA
2103K00000XBehavior AnalystABA-B-10253820OR

General Provider Information

NPI Number : 1861903460
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN RYAN BCBA
Provider Business Mailing Address
First Line : 1333 S MAYFLOWER AVE STE 220
Second Line :
City : MONROVIA
State : CA
Zip : 91016-5239
Country : US
Telephone Number : 818-241-6780
Fax Number : 888-588-2752
Provider Business Practice Location Address
First Line : 4620 SE INTERNATIONAL WAY STE 103
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4660
Country : US
Telephone Number : 855-295-3276
Fax Number : 888-588-2752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2017
Last Update Date : 05/28/2025

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Directions to “ KATHLEEN RYAN BCBA” Practice Location

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