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General NPI Number Information
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NPI Number | 1457147886
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Entity Type | Individual
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Provider Name | JASPER ELIJAH RYAN
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 748 MARKET ST # 157
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City | TACOMA
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State | WA
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Zip | 98402-3737
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Country | US
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Telephone | 253-778-1017
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Fax |
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Provider Business Mailing Address
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Address Line | 810 S 14TH ST APT 114
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City | TACOMA
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State | WA
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Zip | 98405-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB61525877
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License Number State | WA
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