Provider Demographics
NPI:1578826624
Name:HICKMAN, ADA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:ELIZABETH
Last Name:HICKMAN
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 1:3599 GREENS MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2126
Mailing Address - Country:US
Mailing Address - Phone:931-215-7294
Mailing Address - Fax:
Practice Address - Street 1:3599 GREENS MILL RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2126
Practice Address - Country:US
Practice Address - Phone:931-215-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist