Provider Demographics
NPI:1194084855
Name:RYAN, MARTHA KENDALL (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:KENDALL
Last Name:RYAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 S CHERRY ST
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2699
Mailing Address - Country:US
Mailing Address - Phone:303-282-1791
Mailing Address - Fax:303-758-9334
Practice Address - Street 1:950 S CHERRY ST
Practice Address - Street 2:SUITE 1240
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2699
Practice Address - Country:US
Practice Address - Phone:303-282-1791
Practice Address - Fax:303-758-9334
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical