Provider Demographics
NPI:1174531701
Name:RICKER, VALERIE JEAN (RD)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:JEAN
Last Name:RICKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:VALERIE
Other - Middle Name:JEAN
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:656 AGENCY MAIN ST
Mailing Address - Street 2:FORT BELKNAP INDIAN COMMUNITY
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9455
Mailing Address - Country:US
Mailing Address - Phone:406-353-3130
Mailing Address - Fax:
Practice Address - Street 1:669 AGENCY MAIN ST
Practice Address - Street 2:FORT BELKNAP SERVICE UNIT
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9455
Practice Address - Country:US
Practice Address - Phone:406-353-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT347OtherLICENSE NUMBER
MT1174531701Medicaid
MT8HG051Medicare PIN
MT8HG052Medicare PIN