Healthcare Provider Details

I. General information

NPI: 1477488005
Provider Name (Legal Business Name): RYAN LEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 COUNTRY CLUB RD
INDIANOLA IA
50125-1199
US

IV. Provider business mailing address

2209 COUNTRY CLUB RD
INDIANOLA IA
50125-1199
US

V. Phone/Fax

Practice location:
  • Phone: 515-954-0858
  • Fax:
Mailing address:
  • Phone: 515-954-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number137309
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: