Provider Demographics
NPI:1497439442
Name:RICKERT, ABIGAIL JOHANNA (LPC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JOHANNA
Last Name:RICKERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JOHANNA
Other - Last Name:SOERENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1641
Mailing Address - Country:US
Mailing Address - Phone:920-351-4530
Mailing Address - Fax:
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1641
Practice Address - Country:US
Practice Address - Phone:920-351-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10036-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional