Healthcare Provider Details

I. General information

NPI: 1174531701
Provider Name (Legal Business Name): VALERIE JEAN RICKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE JEAN PRATT RD

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AGENCY MAIN ST FORT BELKNAP SERVICE UNIT
HARLEM MT
59526-9455
US

IV. Provider business mailing address

656 AGENCY MAIN ST FORT BELKNAP INDIAN COMMUNITY
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3130
  • Fax:
Mailing address:
  • Phone: 406-353-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number347
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: