Provider Demographics
NPI:1255687232
Name:HICKS, CHRISTOPHER R (HAS, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:R
Last Name:HICKS
Suffix:
Gender:M
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 HARBOR BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2473
Mailing Address - Country:US
Mailing Address - Phone:850-243-3196
Mailing Address - Fax:850-243-8294
Practice Address - Street 1:122 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4917
Practice Address - Country:US
Practice Address - Phone:850-243-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3760237700000X
AL4134237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist