Individual
RITA DYANNE ICKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 W COTA ST, SHELTON, WA 98584-2265
(360) 205-8001
Mailing address
309 Y ST SW, TUMWATER, WA 98501-5263
(360) 205-8001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CAAR.CG.61414172
WA
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/22/2023
Last updated
04/06/2026
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