Provider Demographics
NPI:1922128800
Name:ILLES, RICKI LEBLANG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RICKI
Middle Name:LEBLANG
Last Name:ILLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9335 RIVIERA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3453
Mailing Address - Country:US
Mailing Address - Phone:303-741-2212
Mailing Address - Fax:303-804-0173
Practice Address - Street 1:5650 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2307
Practice Address - Country:US
Practice Address - Phone:303-741-2212
Practice Address - Fax:303-804-0173
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9918491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical