Most Relevant Information
Provider Data
| NPI Number: | 1003544784 |
| Provider Name: | RYAN MCMICKING |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-22-226946 |
Most Important Dates
| Enumeration Date: | 08/10/2022 |
| Last Updated: | 08/10/2022 |
Provider Practice Location
85 REVERE DR STE AA
NORTHBROOK
IL
600628001
Practice Location Phone/Fax
| Phone: | 8442477222 |
| Fax: | 2154898766 |
Provider Mailing Location
PO BOX 639561
CINCINNATI
OH
452639561
Provider Mailing Phone/Fax
| Phone: | 8442477222 |
| Fax: | 2154898766 |