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General NPI Number Information
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NPI Number | 1710522719
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Entity Type | Individual
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Provider Name | RYANNE MANN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 39420 LIBERTY ST STE 150
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City | FREMONT
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State | CA
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Zip | 94538-2284
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Country | US
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Telephone | 510-794-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 2748 NE OCKER DR
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City | BEND
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State | OR
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Zip | 97701-6408
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Country | US
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Telephone | 406-471-4253
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | ABA-B-10233450
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License Number State | OR
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