Provider Demographics
NPI:1083448096
Name:HUKILL, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HUKILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 W 71ST ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1174
Mailing Address - Country:US
Mailing Address - Phone:331-645-6982
Mailing Address - Fax:
Practice Address - Street 1:7209 W 71ST ST APT 203
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1174
Practice Address - Country:US
Practice Address - Phone:331-645-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-75003103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst