Basic Information
| Provider Information | |||||||||
| NPI: | 1154663433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | ALLISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983371028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607314796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 NW BUCKLIN HILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603372222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CG60339747 | WA | N | Behavioral Health & Social Service Providers | Counselor | 103K00000X | 1-17-25181 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.