Provider Demographics
NPI:1164724316
Name:RICKS, HEIDI I
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RICKS
Suffix:I
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 1:37 SAUNDERS LN
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1929
Mailing Address - Country:US
Mailing Address - Phone:518-588-7122
Mailing Address - Fax:518-244-8029
Practice Address - Street 1:406 FULTON ST
Practice Address - Street 2:SUITE 513
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3359
Practice Address - Country:US
Practice Address - Phone:518-588-7122
Practice Address - Fax:518-244-8029
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0051633176B00000X
NYP78239176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife