Provider Demographics
NPI:1730799388
Name:DREXLER, RIAN ELLINWOOD
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:ELLINWOOD
Last Name:DREXLER
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:S5789 S SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9235
Mailing Address - Country:US
Mailing Address - Phone:608-963-8032
Mailing Address - Fax:
Practice Address - Street 1:1600 BROADWAY STE 1606
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4927
Practice Address - Country:US
Practice Address - Phone:303-386-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst