Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 492 | CO |
NPI | 1003193079 |
---|---|
Provider Name | Mrs. Lani R. Hickman |
First Address | Fort Collins, CO 80525-5741 |
Second Address | Fort Collins, CO 80525-5741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2011 |
Last Update Date | 04/11/2011 |