Active NPI
Kristi Ickes, LCSW
- Clinical Social Worker
- Peoria, AZ
National Provider Identifier
1508178278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12185
- Practice address
- 8155 W Thunderbird Rd
Peoria, AZ 85381-4159 - Phone
- (623) 336-0164
- NPI assigned
- Jul 9, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12185 | AZ | Primary |
Addresses
Primary practice location
8155 W Thunderbird Rd
Peoria, AZ 85381-4159
Mailing address
PO Box 3066
Peoria, AZ 85380-3066
Phone (623) 336-0164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12185 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278633600000",
"number": "1508178278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3066",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853803066",
"telephone_number": "623-336-0164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8155 W THUNDERBIRD RD",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814159",
"telephone_number": "623-336-0164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICKES",
"first_name": "KRISTI",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-09",
"last_updated": "2010-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "12185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.