Healthcare Provider Details

I. General information

NPI: 1902683535
Provider Name (Legal Business Name): RYAN ROSE HATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 S STREAM BLVD STE 300
CHARLOTTE NC
28217-0143
US

IV. Provider business mailing address

4235 S STREAM BLVD STE 300
CHARLOTTE NC
28217-0143
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: