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NPI Code Detail

MEDICARE: KATHERINE RYAN EDS

MEDICARE: KATHERINE RYAN EDS
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
1103TS0200XSchool Psychologist220103399CA

General Provider Information

NPI Number : 1831982792
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE RYAN EDS
Provider Business Mailing Address
First Line : 1500 LIZZIE ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-3062
Country : US
Telephone Number : 805-549-1220
Fax Number :
Provider Business Practice Location Address
First Line : 1500 LIZZIE ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-3062
Country : US
Telephone Number : 805-549-1220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2025
Last Update Date : 05/23/2025

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