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NPI Code Detail

MEDICARE: RYAN LANDVATTER

MEDICARE: RYAN LANDVATTER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1790491918
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN LANDVATTER
Provider Business Mailing Address
First Line : 6140 W EXECUTIVE DR STE B
Second Line :
City : MEQUON
State : WI
Zip : 53092-4499
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6140 W EXECUTIVE DR STE B
Second Line :
City : MEQUON
State : WI
Zip : 53092-4499
Country : US
Telephone Number : 262-388-7151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2023
Last Update Date : 01/31/2023

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Directions to “ RYAN LANDVATTER ” Practice Location

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