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General NPI Number Information
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NPI Number | 1831170018
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Entity Type | Individual
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Provider Name | MARY ANN RIKSHEIM MSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 3612 LINCOLN HWY SUITE 14B
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1627
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Country | US
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Telephone | 708-748-8309
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Fax | 708-748-8309
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Provider Business Mailing Address
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Address Line | 3612 LINCOLN HWY SUITE 14B
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1627
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Country | US
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Telephone | 708-748-8309
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Fax | 708-748-8351
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-002586
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License Number State | IL
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