Provider Demographics
NPI:1114963089
Name:RICKETTS, FRANCES BERNANDINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:BERNANDINE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRANCY
Other - Middle Name:B
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2208 7TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2604
Mailing Address - Country:US
Mailing Address - Phone:309-786-1569
Mailing Address - Fax:309-786-2201
Practice Address - Street 1:2208 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2604
Practice Address - Country:US
Practice Address - Phone:309-786-1569
Practice Address - Fax:309-786-2201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004493103TC0700X
IA00033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
188390OtherMANAGED HEALTH NETWORK
08122334OtherBLUE CROSS BLUE SHIELD
5066340OtherAETNA
MIS207028000OtherMAGELLAN
104119200OtherDEPT OF LABOR OWEP
IAMIS061227002Medicaid
245866OtherMIDLANDS CHOICE
08122334OtherBLUE CROSS BLUE SHIELD
188390OtherMANAGED HEALTH NETWORK