Provider Demographics
NPI:1255811592
Name:BLEJEWSKI, RYAN CHARLES (BCBA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHARLES
Last Name:BLEJEWSKI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2937
Mailing Address - Country:US
Mailing Address - Phone:910-769-3571
Mailing Address - Fax:
Practice Address - Street 1:720 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2937
Practice Address - Country:US
Practice Address - Phone:919-660-8200
Practice Address - Fax:910-660-8199
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-29731103K00000X
NC5437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst