Provider Demographics
NPI:1659912343
Name:BUSHONG, RYLEY ANN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:RYLEY
Middle Name:ANN
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:RYLEY
Other - Middle Name:ANN
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:1558 E BOULEVARD STE A
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2587
Practice Address - Country:US
Practice Address - Phone:765-252-0530
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN1-22-60969103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid
IN1-22-60969OtherBCBA CERTIFICATION