Provider Demographics
NPI:1023028990
Name:HICKS, SUE MARIE (LCSW, CADC III)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 S STIBNITE AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1990
Mailing Address - Country:US
Mailing Address - Phone:208-740-0391
Mailing Address - Fax:
Practice Address - Street 1:500 W. FORT ST.
Practice Address - Street 2:BOISE VAMC
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-422-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-04-97101YA0400X
IDLCSW-271351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical