Provider Demographics
NPI:1447737168
Name:HICKS, DAMON LOWELL
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:LOWELL
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 SAINT JEAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-3859
Mailing Address - Country:US
Mailing Address - Phone:317-753-6294
Mailing Address - Fax:
Practice Address - Street 1:6342 SAINT JEAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-3859
Practice Address - Country:US
Practice Address - Phone:317-753-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator