MEDICARE: DR. RYAN A LEIKER PH.D., MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	14781	TX

General Provider Information

NPI Number	:	1194232793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN A LEIKER PH.D., MA

Provider Business Mailing Address
First Line	:	1340 PRUDENTIAL DR STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 PRUDENTIAL DR # A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:	214-810-0837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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Directions to “ DR. RYAN A LEIKER PH.D., MA” Practice Location

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