Provider Demographics
NPI:1215777834
Name:TRAVINSKI, DICKIE M (PRSS)
Entity type:Individual
Prefix:
First Name:DICKIE
Middle Name:M
Last Name:TRAVINSKI
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2002
Mailing Address - Country:US
Mailing Address - Phone:318-222-8511
Mailing Address - Fax:318-317-3333
Practice Address - Street 1:527 CROCKETT ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3601
Practice Address - Country:US
Practice Address - Phone:318-222-8511
Practice Address - Fax:318-317-3333
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOBHPSS1038175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator