MEDICARE: RYAN J MACKS PH.D.

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	6162	OH

General Provider Information

NPI Number	:	1588607279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN J MACKS PH.D.

Provider Business Mailing Address
First Line	:	7799 JOAN DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3682
Country	:	US
Telephone Number	:	513-204-5746
Fax Number	:	513-229-3707

Provider Business Practice Location Address
First Line	:	7799 JOAN DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3682
Country	:	US
Telephone Number	:	513-204-5746
Fax Number	:	513-229-3707

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	12/01/2016

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