Provider Demographics
NPI:1093494189
Name:HICKERSON, MADELINE JADE XIAO
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:JADE XIAO
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12250 SW PIONEER LN APT 351
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8341
Mailing Address - Country:US
Mailing Address - Phone:503-999-5077
Mailing Address - Fax:
Practice Address - Street 1:12250 SW PIONEER LN APT 351
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8341
Practice Address - Country:US
Practice Address - Phone:503-999-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst