MEDICARE: RYAN TALASKI

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902578933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN TALASKI

Provider Business Mailing Address
First Line	:	908 S SHERIDAN ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7429
Country	:	US
Telephone Number	:	989-395-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 S SHERIDAN ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7429
Country	:	US
Telephone Number	:	989-395-1461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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Directions to “ RYAN TALASKI ” Practice Location

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