Provider Demographics
NPI:1275071847
Name:RICKARD, SANDRA LOU
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOU
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 1:915 S DAVID ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3737
Mailing Address - Country:US
Mailing Address - Phone:307-472-3769
Mailing Address - Fax:307-472-3707
Practice Address - Street 1:915 S DAVID ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3737
Practice Address - Country:US
Practice Address - Phone:307-472-3769
Practice Address - Fax:307-472-3707
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYN/AOtherNON MEDICAID