Healthcare Provider Details

I. General information

NPI: 1265851414
Provider Name (Legal Business Name): GLORIA JEAN RYDER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 S 8TH ST STE 120
COLORADO SPRINGS CO
80905-1926
US

IV. Provider business mailing address

1757 S 8TH ST STE 120
COLORADO SPRINGS CO
80905-1926
US

V. Phone/Fax

Practice location:
  • Phone: 719-201-5735
  • Fax: 719-434-8973
Mailing address:
  • Phone: 719-201-5735
  • Fax: 719-434-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: