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General NPI Number Information
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NPI Number | 1285742395
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Entity Type | Individual
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Provider Name | KATHRYN MARIE VICKS MSW, LISW-S, LCDC II
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 15 TRAIL EDGE CIR
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City | POWELL
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State | OH
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Zip | 43065-9464
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Country | US
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Telephone | 614-561-5261
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Fax |
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Provider Business Mailing Address
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Address Line | 15 TRAIL EDGE CIR
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City | POWELL
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State | OH
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Zip | 43065-9464
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Country | US
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Telephone | 614-561-5261
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21344
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License Number State | AZ
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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 | 1141581
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0800182-SUPV
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License Number State | OH
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