Individual
JAMES RICKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006394A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001058931
ANTHEM PROVIDER NUMBER
IN
05
—
PENDING
—
IN
Enumeration date
07/12/2016
Last updated
01/20/2017
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