Provider Demographics
NPI:1538723846
Name:VICK, RHONDA (LCSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:VICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7108
Mailing Address - Country:US
Mailing Address - Phone:406-260-6265
Mailing Address - Fax:
Practice Address - Street 1:2290 FARM TO MARKET RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7108
Practice Address - Country:US
Practice Address - Phone:406-260-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-375961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical