Provider Demographics
NPI:1508492844
Name:HICKS, JENNIFER (MT-BC, E-RYT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MT-BC, E-RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13228 SPENCER SWEET PEA LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2181
Mailing Address - Country:US
Mailing Address - Phone:952-913-8675
Mailing Address - Fax:
Practice Address - Street 1:13228 SPENCER SWEET PEA LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-2181
Practice Address - Country:US
Practice Address - Phone:952-913-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist