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General NPI Number Information
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NPI Number | 1811946106
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Entity Type | Individual
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Provider Name | PATRICIA RYAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 5445 GRAND AVE. STE. 206
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City | GURNEE
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State | IL
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Zip | 60031
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Country | US
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Telephone | 847-650-1317
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Fax | 847-847-7657
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Provider Business Mailing Address
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Address Line | 5445 GRAND AVE. STE. 206
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City | GURNEE
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State | IL
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Zip | 60031
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Country | US
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Telephone | 847-650-1317
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Fax | 847-847-7657
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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 | 071005170
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License Number State | IL
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