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General NPI Number Information
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NPI Number | 1326171083
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Entity Type | Organization
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Legal Business Name | VIRGINIA RICKERTSEN
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 N 20TH AVE
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City | PASCO
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State | WA
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Zip | 99301-4963
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Country | US
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Telephone | 509-547-9545
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Fax | 509-546-0557
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Provider Business Mailing Address
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Address Line | 303 N 20TH AVE
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City | PASCO
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State | WA
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Zip | 99301-4963
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Country | US
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Telephone | 509-547-9545
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Fax | 509-546-0557
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA RICKERTSEN
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Credential | CDP
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Telephone | 509-547-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WA
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