Individual
MS. RICKIE INEZ BERRETT LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5965 S 900 E, SALT LAKE CITY, UT 84121-1720
(801) 263-7225
(801) 263-7279
Mailing address
5576 ALPINE POINT CIR, SALT LAKE CITY, UT 84118-9275
(801) 835-3511
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
139965-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107001381101
INTERMOUNTAIN HEALTH CARE
UT
01
—
262030
DESERT MUTUAL
UT
01
—
942938348
CHAMPUS
UT
01
—
942938348LA1
EDUCATORS MUTUAL
UT
Enumeration date
01/27/2006
Last updated
11/19/2010
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