Provider Demographics
NPI:1982902656
Name:SHIPOWICK, RYAN ANDREW
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ANDREW
Last Name:SHIPOWICK
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:PO BOX 1595
Mailing Address - Street 2:1520 KELLY PLACE 2ND FLOOR
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0329
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:
Practice Address - Street 1:1520 KELLEY PL FL 2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health