Provider Demographics
NPI:1205063096
Name:BOBST, RYAN (BASW)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:BOBST
Suffix:
Gender:M
Credentials:BASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 N JONES BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9160
Mailing Address - Country:US
Mailing Address - Phone:563-320-1315
Mailing Address - Fax:
Practice Address - Street 1:1229 W 8TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1331
Practice Address - Country:US
Practice Address - Phone:563-322-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program