Individual
ROBERTA T RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
522 SW 5TH AVE, SUITE 725, PORTLAND, OR 97204-2133
(503) 222-2448
(503) 222-2395
Mailing address
522 SW 5TH AVE, SUITE 725, PORTLAND, OR 97204-2133
(503) 222-2448
(503) 222-2395
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1427
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J930714
PACIFIC SOURCE
—
Enumeration date
07/25/2006
Last updated
07/08/2007
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