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General NPI Number Information
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NPI Number | 1679914121
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Entity Type | Individual
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Provider Name | RYAN THOMPSON PSY.D
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Gender | Male
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 501 N VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1818
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Country | US
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Telephone | 540-466-1004
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Fax | 540-227-6879
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Provider Business Mailing Address
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Address Line | 2355 STATE ST STE 101
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City | SALEM
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State | OR
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Zip | 97301-4541
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Country | US
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Telephone | 540-466-1004
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Fax | 540-227-6879
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005777
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License Number State | VA
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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 | P-2994
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3612
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License Number State | OR
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