MEDICARE: EDWARD RICKERT LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5615096	OTHER	IL	BC/BS OF ILLINOIS

General Provider Information

NPI Number	:	1457362667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD RICKERT LCPC

Provider Business Mailing Address
First Line	:	4100 VETERANS PKWY
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 VETERANS PKWY
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:	815-385-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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Directions to “ EDWARD RICKERT LCPC” Practice Location

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