Provider Demographics
NPI:1154527471
Name:RICKARD, JANE ANN (MED)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:RICKARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 S MARLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2670
Mailing Address - Country:US
Mailing Address - Phone:417-883-6529
Mailing Address - Fax:417-883-6529
Practice Address - Street 1:304 W ERIE ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4915
Practice Address - Country:US
Practice Address - Phone:417-881-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0040081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical