Healthcare Provider Details

I. General information

NPI: 1467445353
Provider Name (Legal Business Name): PAMELA A RYAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E 2ND AVE
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

134 E 2ND AVE
WILLIAMSON WV
25661-3602
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-1200
  • Fax: 304-235-1945
Mailing address:
  • Phone: 304-235-1200
  • Fax: 304-235-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number811
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: