Provider Demographics
NPI:1003962655
Name:HICKS, ELIZABETH AMY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMY
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:AMY
Other - Last Name:KOSANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2599
Mailing Address - Fax:206-987-2599
Practice Address - Street 1:1000 BELLINGER RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7574
Practice Address - Country:US
Practice Address - Phone:858-775-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89215208000000X
WAMA61457610225700000X
WABC60332422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist