Ricketts, Mary G

Ricketts, Mary G is an individual health care provider with primary practice located at 2215 E 52Nd St Ste 2 , Davenport IA 52807-2786. She recently has only one registered license in Speech, Language and Hearing Service Providers / Hearing Instrument Specialist, which is considered as her primary health care specialty. Ricketts, Mary G can be contacted via phone (563) 355-7712.

Contact Information

Primary practice address
2215 E 52Nd St Ste 2 Davenport IA 52807-2786
Phone: (563) 355-7712
Fax: (563) 359-1325
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Hearing Instrument Specialist 237700000X 673 Iowa

Profile Details

NPI number 1457365520
LBN Legal business name Ricketts, Mary G
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457365520 NPPES
Iowa MEDICAID 0234526

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