Provider Demographics
NPI:1376835538
Name:HICKSON, LAUREN E (LISW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:HICKSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 DORCHESTER SQ S
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7302
Mailing Address - Country:US
Mailing Address - Phone:614-569-8205
Mailing Address - Fax:614-567-2525
Practice Address - Street 1:168 DORCHESTER SQ S
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7302
Practice Address - Country:US
Practice Address - Phone:614-569-8205
Practice Address - Fax:614-567-2525
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 11000931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical