Provider Demographics
NPI:1619727062
Name:RICKERFOR, KATELYN (BS, MBA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:RICKERFOR
Suffix:
Gender:F
Credentials:BS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 BAUVAIS ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5040
Mailing Address - Country:US
Mailing Address - Phone:504-387-4491
Mailing Address - Fax:
Practice Address - Street 1:3749 BAUVAIS ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5040
Practice Address - Country:US
Practice Address - Phone:504-387-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician