Provider Demographics
NPI:1215444641
Name:BALICKI, CORREEN AVON (LMT, CMT)
Entity type:Individual
Prefix:
First Name:CORREEN
Middle Name:AVON
Last Name:BALICKI
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6979 HOYT CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1665
Mailing Address - Country:US
Mailing Address - Phone:970-333-7012
Mailing Address - Fax:
Practice Address - Street 1:6979 HOYT CT
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-1665
Practice Address - Country:US
Practice Address - Phone:970-333-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist