Provider Demographics
NPI:1952100356
Name:SKINNER, RYLEY (PHD)
Entity type:Individual
Prefix:
First Name:RYLEY
Middle Name:
Last Name:SKINNER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 E 21ST ST N STE 401
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3581
Mailing Address - Country:US
Mailing Address - Phone:316-867-3434
Mailing Address - Fax:316-867-3435
Practice Address - Street 1:10111 E 21ST ST N STE 401
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3581
Practice Address - Country:US
Practice Address - Phone:316-867-3434
Practice Address - Fax:316-867-3435
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03377103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical