Basic Information
| Provider Information | |||||||||
| NPI: | 1134784184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYPOOL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 FORUM BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035454 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2620 FORUM BLVD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652036520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735148735 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 2019014653 | MO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.