Provider Demographics
NPI:1013003953
Name:RICKERT, ROBYN L (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:RICKERT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E WALNUT ST STE 406
Mailing Address - Street 2:P.O. BOX 1108
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4231
Mailing Address - Country:US
Mailing Address - Phone:920-884-1187
Mailing Address - Fax:920-227-4100
Practice Address - Street 1:130 E WALNUT ST
Practice Address - Street 2:SUITE 406
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4239
Practice Address - Country:US
Practice Address - Phone:920-884-1187
Practice Address - Fax:920-227-4100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2975125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39798500Medicaid