Provider Demographics
NPI:1588051676
Name:RIDLEY, PATRICIA FISKE (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:FISKE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26697B PLEASANT PARK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7739
Mailing Address - Country:US
Mailing Address - Phone:303-818-1313
Mailing Address - Fax:
Practice Address - Street 1:26697B PLEASANT PARK RD
Practice Address - Street 2:STE 250
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7739
Practice Address - Country:US
Practice Address - Phone:303-818-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO867042OtherBEACON HEALTH
CO77030257OtherHEALTH FIRST COLORADO MEDICAID