Provider Demographics
NPI:1417142449
Name:HICKS, MICHAEL JOE (AUD,CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOE
Last Name:HICKS
Suffix:
Gender:M
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-6032
Mailing Address - Country:US
Mailing Address - Phone:618-638-4913
Mailing Address - Fax:618-564-3206
Practice Address - Street 1:28 CHICK ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2467
Practice Address - Country:US
Practice Address - Phone:618-638-4913
Practice Address - Fax:618-564-3206
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000631237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist