Healthcare Provider Details

I. General information

NPI: 1790440212
Provider Name (Legal Business Name): CODI RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 BALLARD LN
NEW ALBANY IN
47150-7200
US

IV. Provider business mailing address

550 CONGRESSIONAL BLVD STE 220
CARMEL IN
46032-5632
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-2157
  • Fax:
Mailing address:
  • Phone: 317-249-2242
  • Fax: 844-289-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number96000064A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: