Provider Demographics
NPI:1528254430
Name:PASIKOV, IAN DAVID (MA)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:DAVID
Last Name:PASIKOV
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 NORTH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3307
Mailing Address - Country:US
Mailing Address - Phone:303-442-6366
Mailing Address - Fax:
Practice Address - Street 1:954 NORTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3307
Practice Address - Country:US
Practice Address - Phone:303-442-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy