Provider Demographics
NPI:1326788498
Name:SEEDORF, RYAN PAUL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:SEEDORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4521
Mailing Address - Country:US
Mailing Address - Phone:845-702-5852
Mailing Address - Fax:
Practice Address - Street 1:6845 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3107
Practice Address - Country:US
Practice Address - Phone:719-247-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician