Healthcare Provider Details

I. General information

NPI: 1659706836
Provider Name (Legal Business Name): PAMELA RENEE ZICKER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WEBER ST STE 300
COLORADO SPRINGS CO
80903-1241
US

IV. Provider business mailing address

2570 VANTAGE RIDGE CT
COLORADO SPRINGS CO
80919-5557
US

V. Phone/Fax

Practice location:
  • Phone: 785-218-2501
  • Fax:
Mailing address:
  • Phone: 785-218-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW 3657
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW 00991669
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: