Provider Demographics
NPI:1538652060
Name:HICKEN, HALI
Entity Type:Individual
Prefix:
First Name:HALI
Middle Name:
Last Name:HICKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALI
Other - Middle Name:
Other - Last Name:HICKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HALI HICKEN
Mailing Address - Street 1:515 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2801
Mailing Address - Country:US
Mailing Address - Phone:801-935-4171
Mailing Address - Fax:
Practice Address - Street 1:981 E 3665 S
Practice Address - Street 2:
Practice Address - City:S SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84106-4722
Practice Address - Country:US
Practice Address - Phone:435-862-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-18-56962106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician