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General NPI Number Information
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NPI Number | 1801207345
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Entity Type | Organization
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Legal Business Name | RONALD G. RICKNER, PH.D.
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 1535 KILLEARN CENTER BLVD SUITE C-2
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3467
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Country | US
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Telephone | 850-668-0482
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Fax | 850-894-9957
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Provider Business Mailing Address
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Address Line | 1535 KILLEARN CENTER BLVD SUITE C-2
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3467
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Country | US
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Telephone | 850-668-0482
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Fax | 850-894-9957
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RONALD G. RICKNER
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Credential | PH.D.
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Telephone | 850-668-0482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0005144
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License Number State | FL
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