Provider Demographics
NPI:1023459971
Name:JONES, RYAN GRANT (PSYD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:GRANT
Last Name:JONES
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 1:1864 S KENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2323
Mailing Address - Country:US
Mailing Address - Phone:417-880-6838
Mailing Address - Fax:417-374-0074
Practice Address - Street 1:1864 S KENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2323
Practice Address - Country:US
Practice Address - Phone:417-880-6838
Practice Address - Fax:417-374-0074
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020719103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical