Provider Demographics
NPI:1760133433
Name:RYCKMAN, LAUREN NOELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NOELLE
Last Name:RYCKMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 JEFFERSON CIR S
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2660
Mailing Address - Country:US
Mailing Address - Phone:813-220-9659
Mailing Address - Fax:
Practice Address - Street 1:6151 DOVE FIELD CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1309
Practice Address - Country:US
Practice Address - Phone:770-609-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst