Provider Demographics
NPI:1972971729
Name:PATRICIA FISKE RIDLEY, PH.D., LTD.
Entity Type:Organization
Organization Name:PATRICIA FISKE RIDLEY, PH.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:FISKE
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-679-1429
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO867042OtherBEACON