Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2387-57 | WI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2387-57 | WI |
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1225368723 |
---|---|
Provider Name | Dr. Colleen A Ryan |
First Address | Palmyra, WI 53156-9738 |
Second Address | Palmyra, WI 53156-9738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2010 |
Last Update Date | 05/01/2010 |