Provider Demographics
NPI:1477797116
Name:HICKERSON, JOYCE BRANDES (RNCS)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:BRANDES
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:MARIE
Other - Last Name:BRANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7711 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6182
Mailing Address - Country:US
Mailing Address - Phone:208-853-8536
Mailing Address - Fax:208-853-2929
Practice Address - Street 1:7735 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6182
Practice Address - Country:US
Practice Address - Phone:208-853-8536
Practice Address - Fax:208-853-2929
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-26101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor