Provider Demographics
NPI:1609290725
Name:RICKEY, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:RICKEY
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 1:2380 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45113-8326
Mailing Address - Country:US
Mailing Address - Phone:937-289-2515
Mailing Address - Fax:937-289-3608
Practice Address - Street 1:2380 LEBANON RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45113-8326
Practice Address - Country:US
Practice Address - Phone:937-289-2515
Practice Address - Fax:937-289-3608
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 3096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist