Individual
DR. RYAN J LACKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
975 E GARFIELD AVE APT 2, SALT LAKE CITY, UT 84105-3377
(574) 360-6884
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11448769-2501
UT
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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