Provider Demographics
NPI:1659706836
Name:ZICKER, PAMELA RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:ZICKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 VANTAGE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-5557
Mailing Address - Country:US
Mailing Address - Phone:785-218-2501
Mailing Address - Fax:
Practice Address - Street 1:315 N WEBER ST STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1241
Practice Address - Country:US
Practice Address - Phone:785-218-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 3657104100000X
COCSW 009916691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker