Provider Demographics
NPI:1376724914
Name:HICKS, PATRICIA ROGERS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ROGERS
Last Name:HICKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6938
Mailing Address - Country:US
Mailing Address - Phone:603-224-3886
Mailing Address - Fax:603-226-0257
Practice Address - Street 1:131 SHAKER RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6938
Practice Address - Country:US
Practice Address - Phone:603-224-3886
Practice Address - Fax:603-226-0257
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30401076Medicaid