Individual
DR. RANDY LYNN RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
8823 S REDWOOD RD, SUITE B BASEMENT, WEST JORDAN, UT 84088-9281
(801) 913-0098
(801) 272-3857
Mailing address
PO BOX 17586, SALT LAKE CITY, UT 84117-0586
(801) 913-0098
(801) 272-3857
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6390681-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000068519
MEDICARE PTAN
UT
Enumeration date
01/04/2010
Last updated
03/16/2010
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