Provider Demographics
NPI:1114108263
Name:RYAN, LINDA CHRISTINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CHRISTINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:13601 S US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-3659
Mailing Address - Country:US
Mailing Address - Phone:816-966-0338
Mailing Address - Fax:816-966-1023
Practice Address - Street 1:13601 S US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-3659
Practice Address - Country:US
Practice Address - Phone:816-966-0338
Practice Address - Fax:816-966-1023
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0429103TB0200X, 103TC1900X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily