Provider Demographics
NPI:1578188512
Name:HICKS, ELISHA BETH
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:BETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 SPRINGBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9241
Mailing Address - Country:US
Mailing Address - Phone:937-214-3903
Mailing Address - Fax:
Practice Address - Street 1:1090 SPRINGBROOK LN
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9241
Practice Address - Country:US
Practice Address - Phone:937-214-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No253J00000XAgenciesFoster Care Agency