Provider Demographics
NPI:1598957078
Name:HICKETHIER, DEBRA ANN (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:HICKETHIER
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4502
Mailing Address - Country:US
Mailing Address - Phone:505-718-6885
Mailing Address - Fax:
Practice Address - Street 1:615 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4502
Practice Address - Country:US
Practice Address - Phone:505-718-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE