Provider Demographics
NPI:1417463068
Name:NIPPES, RYAN (BSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:NIPPES
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TREASURE CAY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5373
Mailing Address - Country:US
Mailing Address - Phone:772-323-4274
Mailing Address - Fax:
Practice Address - Street 1:1302 N LAWNWOOD CR
Practice Address - Street 2:SUITE B
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-468-6800
Practice Address - Fax:772-464-3800
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)