Provider Demographics
NPI:1003193079
Name:HICKMAN, LANI R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LANI
Middle Name:R
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 LOWE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5741
Mailing Address - Country:US
Mailing Address - Phone:970-266-1778
Mailing Address - Fax:970-266-1799
Practice Address - Street 1:2032 LOWE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5741
Practice Address - Country:US
Practice Address - Phone:970-266-1778
Practice Address - Fax:970-266-1799
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical