Healthcare Provider Details

I. General information

NPI: 1093180689
Provider Name (Legal Business Name): ASHLEY RICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
MIDDLEBURY VT
05753-1459
US

IV. Provider business mailing address

89 MAIN ST
MIDDLEBURY VT
05753-1459
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-0302
  • Fax: 802-388-8183
Mailing address:
  • Phone: 802-388-0302
  • Fax: 802-388-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000689
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: