Provider Demographics
NPI:1982337945
Name:RICKERT, NANCY SUE (PLPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:RICKERT
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 COLLIER CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6701
Mailing Address - Country:US
Mailing Address - Phone:636-255-0002
Mailing Address - Fax:636-634-4777
Practice Address - Street 1:9378 OLIVE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3223
Practice Address - Country:US
Practice Address - Phone:314-315-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health