Healthcare Provider Details

I. General information

NPI: 1508175274
Provider Name (Legal Business Name): BREE RICKER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N OAK ST
COLUMBIA CITY IN
46725-1608
US

IV. Provider business mailing address

360 N OAK ST
COLUMBIA CITY IN
46725-1608
US

V. Phone/Fax

Practice location:
  • Phone: 260-249-5432
  • Fax:
Mailing address:
  • Phone: 260-249-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: