Healthcare Provider Details

I. General information

NPI: 1720439888
Provider Name (Legal Business Name): MR. RYAN WILLIAM MEIERDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 NE HIGHWAY 99 # 125
VANCOUVER WA
98686-5613
US

IV. Provider business mailing address

10604 NE HIGHWAY 99 # 125
VANCOUVER WA
98686-5613
US

V. Phone/Fax

Practice location:
  • Phone: 360-644-1631
  • Fax:
Mailing address:
  • Phone: 360-644-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: