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General NPI Number Information
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NPI Number | 1275146599
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Entity Type | Individual
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Provider Name | RYAN MATHER PSYD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 1610
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City | CHICAGO
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State | IL
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Zip | 60602-3653
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Country | US
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Telephone | 773-234-7509
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Fax |
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Provider Business Mailing Address
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Address Line | 6177 N LINCOLN AVE # 197
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City | CHICAGO
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State | IL
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Zip | 60659-2313
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Country | US
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Telephone | 773-234-7509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071010711
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License Number State | IL
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