Provider Demographics
NPI:1598353591
Name:HICKS, TRINA MARIE
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:MARIE
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 1:1929 FIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3519
Mailing Address - Country:US
Mailing Address - Phone:567-868-4898
Mailing Address - Fax:
Practice Address - Street 1:1929 FIRLAWN DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3519
Practice Address - Country:US
Practice Address - Phone:567-868-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4810250OtherDODD PROVIDER NUMBER