Healthcare Provider Details

I. General information

NPI: 1073157962
Provider Name (Legal Business Name): ALIX RENEE DINGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALIX RENEE TUCKER LCSW

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BOARDWALK DR
FORT COLLINS CO
80525-5945
US

IV. Provider business mailing address

4115 BOARDWALK DR
FORT COLLINS CO
80525-5945
US

V. Phone/Fax

Practice location:
  • Phone: 970-453-4580
  • Fax: 970-797-2859
Mailing address:
  • Phone: 970-453-4580
  • Fax: 970-737-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22844
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09926837
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: