Physician Compare National (NPI:1629270905)

HEALTHCARE PROVIDER: DAYNEN JEAN LALICKER LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629270905
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022397835
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161118001859
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LALICKER
	Individual professional last name
Provider First Name	DAYNEN
	Individual professional first name
Provider Middle Name	JEAN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	209 S MONTANA ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B6
	Group Practice or individual's line 2 address
City	BUTTE
	Group Practice or individual's city
State	MT
	Group Practice or individual's state
Zip Code	597011645
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y