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General NPI Number Information
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NPI Number | 1902862188
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Entity Type | Individual
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Provider Name | MIRIAM RUTH IKER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21 WILLOW POND WAY SUITE 210
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City | PENFIELD
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State | NY
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Zip | 14526-2687
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Country | US
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Telephone | 585-377-3540
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Fax | 585-377-3553
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Provider Business Mailing Address
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Address Line | 21 WILLOW POND WAY SUITE 210
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City | PENFIELD
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State | NY
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Zip | 14526-2687
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Country | US
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Telephone | 585-377-3540
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Fax | 585-377-3553
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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 | 011264-1
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License Number State | NY
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