Provider Demographics
NPI:1548322910
Name:RYAN, PATRICK KELAHER (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KELAHER
Last Name:RYAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2413
Mailing Address - Country:US
Mailing Address - Phone:586-465-7790
Mailing Address - Fax:586-464-7900
Practice Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2413
Practice Address - Country:US
Practice Address - Phone:586-465-7790
Practice Address - Fax:586-464-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002940103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist