Provider Demographics
NPI:1487628491
Name:HICKMAN, JEWELL PATRICIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEWELL
Middle Name:PATRICIA
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 EDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5419
Mailing Address - Country:US
Mailing Address - Phone:314-503-2696
Mailing Address - Fax:314-344-0983
Practice Address - Street 1:11138 OLD SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2113
Practice Address - Country:US
Practice Address - Phone:314-344-0983
Practice Address - Fax:314-344-0983
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010842101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional