MEDICARE: DR. RYAN WALSH 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

General Provider Information

NPI Number	:	1679915755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN WALSH PH.D.

Provider Business Mailing Address
First Line	:	8084 WATSON RD STE 245
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5326
Country	:	US
Telephone Number	:	314-887-3304
Fax Number	:

Provider Business Practice Location Address
First Line	:	8084 WATSON RD STE 245
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5326
Country	:	US
Telephone Number	:	314-887-3304
Fax Number	:

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	03/26/2026

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