RYAN MANGUM PHD NPI 1790311157

NPI Information

NPI: 1790311157
Provider Name: RYAN MANGUM, PHD
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
600 N ROBBINS RD
BOISE, ID
ZIP 83702
Phone: (208) 381-9037
Get Directions

Ryan Mangum, PHD is a clinical neuropsychologist in Boise, ID with 6 years of experience. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. Ryan Mangum, PHD NPI is 1790311157. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

600 N ROBBINS RD
BOISE, ID
ZIP 83702-565
Phone: (208) 381-9037

The NPI 1790311157 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 3/18/2020 and was last updated on 3/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103G00000X	Clinical Neuropsychologist		PY61070460	WASHINGTON	No
2	103TC0700X	Psychologist	Clinical	6301018219	MICHIGAN	No
3	103TC0700X	Psychologist	Clinical	PY61070460	WASHINGTON	No
4	103G00000X	Clinical Neuropsychologist		PSY-203778	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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