Healthcare Provider Details

I. General information

NPI: 1457843005
Provider Name (Legal Business Name): AMY LYNN RYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 RIVERSIDE AVE
FORT COLLINS CO
80524-4387
US

IV. Provider business mailing address

3618 HORSETOOTH CT
FORT COLLINS CO
80526-6403
US

V. Phone/Fax

Practice location:
  • Phone: 970-779-4536
  • Fax:
Mailing address:
  • Phone: 858-342-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0001538
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: