Provider Demographics
NPI:1225195597
Name:HICKEY, DEBORAH L (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:HICKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 20TH ST CT W
Mailing Address - Street 2:STE C
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-565-6809
Mailing Address - Fax:253-565-5899
Practice Address - Street 1:6512 20TH ST CT W
Practice Address - Street 2:STE C
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-565-6809
Practice Address - Fax:253-565-5899
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000015202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39675Medicare UPIN
WAG115001041Medicare ID - Type Unspecified