Provider Demographics
NPI:1063589182
Name:KOLAKOSKI, RYAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:KOLAKOSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 TAYLOR BLVD
Mailing Address - Street 2:STE. 250
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2294
Mailing Address - Country:US
Mailing Address - Phone:925-688-8910
Mailing Address - Fax:925-688-2200
Practice Address - Street 1:391 TAYLOR BLVD
Practice Address - Street 2:STE. 250
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2294
Practice Address - Country:US
Practice Address - Phone:925-688-8910
Practice Address - Fax:925-688-2200
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist