Provider Demographics
NPI:1801207345
Name:RONALD G. RICKNER, PH.D.
Entity Type:Organization
Organization Name:RONALD G. RICKNER, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-668-0482
Mailing Address - Street 1:1535 KILLEARN CENTER BLVD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3467
Mailing Address - Country:US
Mailing Address - Phone:850-668-0482
Mailing Address - Fax:850-894-9957
Practice Address - Street 1:1535 KILLEARN CENTER BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3467
Practice Address - Country:US
Practice Address - Phone:850-668-0482
Practice Address - Fax:850-894-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty