Healthcare Provider Details

I. General information

NPI: 1760902787
Provider Name (Legal Business Name): ANNA DAY RYAN PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 EAST SECOND STREET
DULUTH MN
55805-1913
US

IV. Provider business mailing address

400 EAST THIRD STREET MCL2CRED
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-5360
  • Fax:
Mailing address:
  • Phone: 218-786-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: