Provider Demographics
NPI:1053736553
Name:HENNIG, RYAN CHRISTOPHER (MA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:HENNIG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6221
Mailing Address - Country:US
Mailing Address - Phone:253-961-5417
Mailing Address - Fax:
Practice Address - Street 1:2610 N ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6221
Practice Address - Country:US
Practice Address - Phone:253-961-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60715712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist