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General NPI Number Information
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NPI Number | 1073157962
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Entity Type | Individual
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Provider Name | ALIX RENEE DINGER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4115 BOARDWALK DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-5945
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Country | US
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Telephone | 970-453-4580
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Fax | 970-797-2859
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Provider Business Mailing Address
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Address Line | 4115 BOARDWALK DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-5945
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Country | US
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Telephone | 970-453-4580
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Fax | 970-737-2859
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22844
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09926837
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License Number State | CO
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