Individual ProviderRickie Inez Berrett LakeSocial WorkerBehavioral Health & Social Service ProvidersPractice Address5965 S 900 E, Salt Lake City, UT 84121-1720(801) 263-7225(801) 835-3511PECOS EnrollmentBased on the most recent information from CMS, provider Rickie Inez Berrett Lake does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1942271028Provider TypeIndividualFull NameLake, Rickie Inez BerrettTitleMs.CredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date1/27/2006Last Updated11/19/2010Contact InformationPractice LocationPractice Address5965 S 900 E, Salt Lake City, UT 84121-1720Phone(801) 263-7225Fax(801) 263-7279Mailing LocationMailing Address5576 Alpine Point Cir, Salt Lake City, UT 84118-9275Phone(801) 835-3511FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense139965-3501UtahProvider IdentifiersIDDescriptionIssuerID262030DescriptionOtherIssuerDESERT MUTUALUtahID942938348DescriptionOtherIssuerCHAMPUSUtahID942938348LA1DescriptionOtherIssuerEDUCATORS MUTUALUtahID107001381101DescriptionOtherIssuerINTERMOUNTAIN HEALTH CAREUtah