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General NPI Number Information
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NPI Number | 1932418183
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Entity Type | Individual
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Provider Name | MARY WHITNEY RYAN PHD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 03/02/2024
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Provider Practice Location Address
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Address Line | 330 E LAKESIDE AVE STE B001
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2834
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Country | US
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Telephone | 208-243-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 711 N 8TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4255
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Country | US
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Telephone | 305-710-2877
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8457
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License Number State | FL
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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 | PY60440889
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY60440889
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY60440889
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License Number State | WA
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