Healthcare Provider Details

I. General information

NPI: 1700979598
Provider Name (Legal Business Name): KIRA LEE RICKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W INDIANA AVE
CHESTERTON IN
46304-2349
US

IV. Provider business mailing address

1346 CHALEMEL DR
CHESTERTON IN
46304-1480
US

V. Phone/Fax

Practice location:
  • Phone: 915-730-5390
  • Fax:
Mailing address:
  • Phone: 915-730-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008501A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: