Individual
CLAYTON ICKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
6717 VALMONT RD, BOULDER, CO 80301-4707
(303) 434-9096
Mailing address
6717 VALMONT RD, BOULDER, CO 80301-4707
(303) 434-9096
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW.0009926040
CO
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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