Provider Demographics
NPI:1104540715
Name:WEBSTER, RYAN ILENE (BCBA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ILENE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 50 N STE W8
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2010
Mailing Address - Country:US
Mailing Address - Phone:435-790-2757
Mailing Address - Fax:
Practice Address - Street 1:365 W 50 N STE W8
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2010
Practice Address - Country:US
Practice Address - Phone:435-790-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11273332-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst