Healthcare Provider Details

I. General information

NPI: 1720032006
Provider Name (Legal Business Name): MAUREEN DIXON RICKMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MARSHALL CT
MADISON WI
53705-2255
US

IV. Provider business mailing address

2727 MARSHALL CT
MADISON WI
53705-2255
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-9354
  • Fax: 608-238-7675
Mailing address:
  • Phone: 608-238-9354
  • Fax: 608-238-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2155
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: