Healthcare Provider Details

I. General information

NPI: 1114881935
Provider Name (Legal Business Name): NICHOLAUS S. RYAN M.S. P.P.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GRAND AVE
OROVILLE CA
95965-4007
US

IV. Provider business mailing address

2828 LEVI LN
CHICO CA
95973-7281
US

V. Phone/Fax

Practice location:
  • Phone: 530-538-8830
  • Fax:
Mailing address:
  • Phone: 530-538-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: