Healthcare Provider Details

I. General information

NPI: 1598390163
Provider Name (Legal Business Name): KELSEY RYCKMAN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WEST ST # 3
ASHLAND NH
03217-4219
US

IV. Provider business mailing address

PO BOX 1150
ASHLAND NH
03217-1150
US

V. Phone/Fax

Practice location:
  • Phone: 603-968-7452
  • Fax: 603-968-7455
Mailing address:
  • Phone: 603-968-7452
  • Fax: 603-968-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3042
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41003
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: