Provider Demographics
NPI:1508932849
Name:HICKS, GAYLE ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ELLEN
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3815
Mailing Address - Country:US
Mailing Address - Phone:858-279-6771
Mailing Address - Fax:858-279-7505
Practice Address - Street 1:2815 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-279-6771
Practice Address - Fax:858-279-7505
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 5112084N0600X, 231H00000X
CAHA 2992237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU511Medicare ID - Type Unspecified