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General NPI Number Information
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NPI Number | 1164724316
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Entity Type | Individual
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Provider Name | HEIDI RICKS I
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Gender | Female
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Dates
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Enumeration Date | 11/21/2010
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 331 USHERS RD STE 7
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-1546
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Country | US
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Telephone | 518-588-7122
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Fax | 518-565-0609
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Provider Business Mailing Address
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Address Line | 77 SAUNDERS LN
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-1929
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Country | US
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Telephone | 518-588-7122
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Fax | 518-244-8029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | P78239
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 107.0051633
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License Number State | VT
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