Healthcare Provider Details

I. General information

NPI: 1407290497
Provider Name (Legal Business Name): PHILIP LOUIS RAMBO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E DOUGLAS AVE STE 200
WICHITA KS
67202-3548
US

IV. Provider business mailing address

801 E DOUGLAS AVE STE 200
WICHITA KS
67202-3548
US

V. Phone/Fax

Practice location:
  • Phone: 316-361-6885
  • Fax:
Mailing address:
  • Phone: 918-289-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1062
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1062
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: