Provider Demographics
NPI:1154766608
Name:RICKABY, TERI MAE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:MAE
Last Name:RICKABY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:M
Other - Last Name:GRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:812 E JOLLY RD STE 311
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6825
Mailing Address - Country:US
Mailing Address - Phone:517-346-8200
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:566 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1033
Practice Address - Country:US
Practice Address - Phone:517-676-2461
Practice Address - Fax:517-676-3265
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH02073537OtherHEALTHPLUS