Provider Demographics
NPI:1619377801
Name:IVENS, RICKY
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:IVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25560 BUSINESS PARK
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-4292
Mailing Address - Country:US
Mailing Address - Phone:302-841-9515
Mailing Address - Fax:
Practice Address - Street 1:25560 BUSINESS PARK
Practice Address - Street 2:UNIT 2A
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-4292
Practice Address - Country:US
Practice Address - Phone:302-841-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002118237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist