Individual
RYAN C DIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
5050 NE HOYT, SUITE 540, PORTLAND, OR 97213-2985
(503) 215-6600
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
16500000
OR
103TC0700X
Clinical Psychologist
Primary
2102
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12152292
CAQH ID
OR
05
—
500626193
—
OR
Enumeration date
09/15/2010
Last updated
10/14/2020
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