Provider Demographics
NPI:1669044046
Name:RICKARD, GABRIANNE ROSE
Entity Type:Individual
Prefix:
First Name:GABRIANNE
Middle Name:ROSE
Last Name:RICKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 W 110TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1585
Mailing Address - Country:US
Mailing Address - Phone:516-665-1869
Mailing Address - Fax:
Practice Address - Street 1:6400 W 110TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1585
Practice Address - Country:US
Practice Address - Phone:816-607-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical