Provider Demographics
NPI:1396369948
Name:HILLIKER, SHANNON NOELLE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NOELLE
Last Name:HILLIKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 E 35TH ST APT 6S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3931
Mailing Address - Country:US
Mailing Address - Phone:949-370-2194
Mailing Address - Fax:
Practice Address - Street 1:282 E 35TH ST APT 6S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3931
Practice Address - Country:US
Practice Address - Phone:949-370-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0885571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical