Provider Demographics
NPI:1952711384
Name:DITTON, RICK (BS PSY)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:DITTON
Suffix:
Gender:M
Credentials:BS PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:WY
Mailing Address - Zip Code:82923-0267
Mailing Address - Country:US
Mailing Address - Phone:307-231-6853
Mailing Address - Fax:
Practice Address - Street 1:798 S FREMONT
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-231-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker