Provider Demographics
NPI:1639497589
Name:RICKERT, MELANIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RICKERT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15379 SILVER BELL RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6023
Mailing Address - Country:US
Mailing Address - Phone:847-525-7605
Mailing Address - Fax:
Practice Address - Street 1:15379 SILVER BELL RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6023
Practice Address - Country:US
Practice Address - Phone:847-525-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst