Provider Demographics
NPI:1629733886
Name:RYAN, COURTNEY CHAPLIN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CHAPLIN
Last Name:RYAN
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:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-1180
Mailing Address - Country:US
Mailing Address - Phone:224-226-2212
Mailing Address - Fax:
Practice Address - Street 1:4006 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4819
Practice Address - Country:US
Practice Address - Phone:262-204-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst