Provider Demographics
NPI:1083350748
Name:VANOVER, RYLEE MCKINSEY
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:MCKINSEY
Last Name:VANOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 N COUNTY ROAD 575 E
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176
Mailing Address - Country:US
Mailing Address - Phone:765-561-7475
Mailing Address - Fax:
Practice Address - Street 1:3532 N COUNTY ROAD 575 E
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176
Practice Address - Country:US
Practice Address - Phone:765-561-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9370028138106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
INHAM3HZN22447440OtherBLUE CROSS BLUE SHIELD