MEDICARE: ALEXANDRA JAYE RICKS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1447001623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA JAYE RICKS MSW

Provider Business Mailing Address
First Line	:	4709 ROWLAND HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-1129
Country	:	US
Telephone Number	:	480-881-8982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 ROWLAND HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-1129
Country	:	US
Telephone Number	:	480-881-8982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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