Healthcare Provider Details

I. General information

NPI: 1790908085
Provider Name (Legal Business Name): PAM HRICIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 TENNYSON ST
DENVER CO
80212-3029
US

IV. Provider business mailing address

2950 TENNYSON ST
DENVER CO
80212-3029
US

V. Phone/Fax

Practice location:
  • Phone: 720-855-3346
  • Fax: 303-433-9701
Mailing address:
  • Phone: 720-855-3346
  • Fax: 303-433-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992424
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: