Healthcare Provider Details

I. General information

NPI: 1962313957
Provider Name (Legal Business Name): OLIVIA RICKS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 NEWTON DR NE
COVINGTON GA
30014-2459
US

IV. Provider business mailing address

10500 CALLAWAY DR UNIT 9205
COVINGTON GA
30014-1253
US

V. Phone/Fax

Practice location:
  • Phone: 270-350-8420
  • Fax:
Mailing address:
  • Phone: 270-350-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP014314
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: