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NPI Code Detail

MEDICARE: RYAN MICHELE KIRK MA, BCBA

MEDICARE: RYAN MICHELE KIRK MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-25-85751OH

General Provider Information

NPI Number : 1003413030
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN MICHELE KIRK MA, BCBA
Provider Business Mailing Address
First Line : 921 BROADUS ST STE B
Second Line :
City : STURGIS
State : MI
Zip : 49091-2403
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 921 BROADUS ST STE B
Second Line :
City : STURGIS
State : MI
Zip : 49091-2403
Country : US
Telephone Number : 833-624-6385
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2020
Last Update Date : 01/02/2026

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