Provider Demographics
NPI:1205199007
Name:DAVLIN, RIKKI M (LCSW)
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:M
Last Name:DAVLIN
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0849
Mailing Address - Country:US
Mailing Address - Phone:208-505-6951
Mailing Address - Fax:888-793-0268
Practice Address - Street 1:4604 N PENNGROVE WAY STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7442
Practice Address - Country:US
Practice Address - Phone:085-056-9512
Practice Address - Fax:888-793-0268
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW321491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20001411OtherMEDICARE PTAN