Provider Demographics
NPI:1508331364
Name:HICKS, EMILY ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2572 WEST TOWNE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:248-895-7669
Mailing Address - Fax:
Practice Address - Street 1:2205 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2970
Practice Address - Country:US
Practice Address - Phone:734-763-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist