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Individual
GLENN BERNARD RICKER
Active
Individual
GLENN BERNARD RICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-1539
AZ
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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