Provider Demographics
NPI:1689295990
Name:VONDENKAMP, RIKKI S
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:S
Last Name:VONDENKAMP
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 1:915 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5309
Mailing Address - Country:US
Mailing Address - Phone:307-922-3499
Mailing Address - Fax:
Practice Address - Street 1:915 7TH ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5309
Practice Address - Country:US
Practice Address - Phone:307-922-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY149618200Medicaid