Provider Demographics
NPI:1275290041
Name:HICKMAN, JACINDA (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-0220
Mailing Address - Country:US
Mailing Address - Phone:304-933-3073
Mailing Address - Fax:
Practice Address - Street 1:141 STATE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1375
Practice Address - Country:US
Practice Address - Phone:304-933-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist