Provider Demographics
NPI:1134504400
Name:RICKARD, STEPHANI M
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:M
Last Name:RICKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1395
Mailing Address - Country:US
Mailing Address - Phone:608-776-4800
Mailing Address - Fax:608-776-4914
Practice Address - Street 1:627 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1395
Practice Address - Country:US
Practice Address - Phone:608-776-4800
Practice Address - Fax:608-776-4914
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker