Provider Demographics
NPI:1699948471
Name:ROBYN RICKERT & ASSOCIATES, LLC
Entity type:Organization
Organization Name:ROBYN RICKERT & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-884-1187
Mailing Address - Street 1:130 E WALNUT ST STE 406
Mailing Address - Street 2:P.O. BOX 1108
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4231
Mailing Address - Country:US
Mailing Address - Phone:920-884-1187
Mailing Address - Fax:920-227-4100
Practice Address - Street 1:130 E WALNUT ST STE 406
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4231
Practice Address - Country:US
Practice Address - Phone:920-884-1187
Practice Address - Fax:920-227-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2775251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health