Individual
DR. JOHN RYAN RODENBOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1126 N CHURCH ST STE 103, GREENSBORO, NC 27401-1035
(336) 663-4900
(336) 663-4920
Mailing address
1200 N ELM ST, GREENSBORO, NC 27401-1004
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2257
NC
103TC0700X
Clinical Psychologist
2257
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0405V
BCBS NC
NC
01
—
5857267
AETNA
NC
01
—
B5701
MEDCOST
NC
Enumeration date
06/10/2006
Last updated
08/13/2021
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