Provider Demographics
NPI:1295285534
Name:RICKERTSEN, ALLYSON B (MS)
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:B
Last Name:RICKERTSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:B
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9415 DUTCH MILL LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5207
Mailing Address - Country:US
Mailing Address - Phone:402-417-2866
Mailing Address - Fax:
Practice Address - Street 1:904 SUMNER ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-434-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health