Provider Demographics
NPI:1063158475
Name:BOUILLION, RYLEE RAE
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:RAE
Last Name:BOUILLION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 STEINER RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8382
Mailing Address - Country:US
Mailing Address - Phone:740-542-9648
Mailing Address - Fax:
Practice Address - Street 1:475 WESTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2288
Practice Address - Country:US
Practice Address - Phone:740-702-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBACB582463103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst