Healthcare Provider Details

I. General information

NPI: 1750194122
Provider Name (Legal Business Name): EVYN E FICKAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 E DRY CREEK RD BLDG C STE 203
CENTENNIAL CO
80112
US

IV. Provider business mailing address

1018 E ELLSWORTH AVE APT 80A
DENVER CO
80209-2382
US

V. Phone/Fax

Practice location:
  • Phone: 720-983-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: