1013003953 NPI number — ROBYN L RICKERT M.S., L.P.C.

Table of content: ROBYN L RICKERT M.S., L.P.C. (NPI 1013003953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013003953 NPI number — ROBYN L RICKERT M.S., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICKERT
Provider First Name:
ROBYN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013003953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 E WALNUT ST STE 406
Provider Second Line Business Mailing Address:
P.O. BOX 1108
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54301-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-884-1187
Provider Business Mailing Address Fax Number:
920-227-4100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 E WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-884-1187
Provider Business Practice Location Address Fax Number:
920-227-4100
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2975125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39798500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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