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General NPI Number Information
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NPI Number | 1851012207
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Entity Type | Individual
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Provider Name | JAMIE LYNN RICKS
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Gender | Female
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 1136 S DELANO CT W STE B201
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City | CHICAGO
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State | IL
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Zip | 60605-3734
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Country | US
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Telephone | 772-459-1237
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 JUSTICE LAKE DR
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City | JOLIET
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State | IL
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Zip | 60432-2894
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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