Provider Demographics
NPI:1073157962
Name:DINGER, ALIX RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:RENEE
Last Name:DINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALIX
Other - Middle Name:RENEE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4115 BOARDWALK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5945
Mailing Address - Country:US
Mailing Address - Phone:970-453-4580
Mailing Address - Fax:970-737-2859
Practice Address - Street 1:4115 BOARDWALK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5945
Practice Address - Country:US
Practice Address - Phone:970-453-4580
Practice Address - Fax:970-797-2859
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22844104100000X
COCSW.099268371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker