Healthcare Provider Details

I. General information

NPI: 1255252136
Provider Name (Legal Business Name): BECCA ICKOWICZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N LOGAN ST UNIT 515
DENVER CO
80203-4470
US

IV. Provider business mailing address

355 N LOGAN ST UNIT 515
DENVER CO
80203-4470
US

V. Phone/Fax

Practice location:
  • Phone: 720-441-3260
  • Fax:
Mailing address:
  • Phone: 720-441-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: