Provider Demographics
NPI:1598478570
Name:RICKETTS, DANIELLE (PRSS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 LENORE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3352
Mailing Address - Country:US
Mailing Address - Phone:614-957-6633
Mailing Address - Fax:
Practice Address - Street 1:1039 LENORE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3352
Practice Address - Country:US
Practice Address - Phone:614-957-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty