Provider Demographics
NPI:1972751782
Name:PICKER, GREG RYAN (PSYD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:RYAN
Last Name:PICKER
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 1:1600 UNIVERSITY AVE W STE 12
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3952
Mailing Address - Country:US
Mailing Address - Phone:651-379-5157
Mailing Address - Fax:
Practice Address - Street 1:1600 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 12
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1234
Practice Address - Country:US
Practice Address - Phone:651-379-5157
Practice Address - Fax:651-379-5159
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4965103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist