Provider Demographics
NPI:1548043706
Name:MEEHL, RYAN G
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:MEEHL
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 1:1400 NORTHDALE BLVD A
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374
Mailing Address - Country:US
Mailing Address - Phone:402-290-4842
Mailing Address - Fax:
Practice Address - Street 1:1400 NORTHDALE BLVD A
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374
Practice Address - Country:US
Practice Address - Phone:402-290-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician