Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ryan Mangum, PHD

Individual provider Clinical Neuropsychologist · NPI 1790311157

Ryan Mangum, PHD is a Clinical Psychologist in Boise, Idaho. Qualified in 2018, 8 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho, Michigan and Washington.

Years since qualifying
8
Licensed in
ID, MI, WA
In the registry since
2020
Specialties on file
4
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

600 N Robbins Rd
Boise, ID 83702-4565
Phone: (208) 381-9037
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2009 F St, Vancouver, WA 98663-3345 — (360) 693-3715

Specialties & licences

Clinical Neuropsychologist (primary) Taxonomy 103G00000X · Licence PSY-203778 (ID)
Clinical Neuropsychologist Taxonomy 103G00000X · Licence PY61070460 (WA)
Clinical Psychologist Taxonomy 103TC0700X · Licence 6301018219 (MI)
Clinical Psychologist Taxonomy 103TC0700X · Licence PY61070460 (WA)

Record details

NPI number1790311157
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorNo
NPI enumeratedMarch 18, 2020
Last updated in NPPESMarch 29, 2023
Certification dateMarch 29, 2023
Mailing address190 E Bannock St, Boise, ID 83712-6241

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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